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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/d2029e61cc63be3fb1d3969311cf1150.pdf?Expires=1712793600&Signature=NaDUvw9Htw-TDp5T1-GjUf1k12tutmQ38twQg7owg2lkSrXxQdn0vX-lbcRiJ5Nry5gNeklgxRfYli5ZDaRTg7vfJRohSBqfFkkU8oAitr-Y8q-NXguPYKn8Lo5FKFbDeMn7OtC%7EpQfOBuCTvZhZcTSPReTf7wqeGnSACp8wAtd2rmbsFiwC3uu6oOEvIZsEZuHxEK57xVJGIQ6T-9IE2ggxr0oDm9OI2hmQeKQuyaZCKuz2b%7ECWr9704swFMtT8W7goMPgJZK1qjqpedGk6vo1Yz93KCIkLd1SmfFYhRTehz3DtARpLY1zguuojRMICPwqR6p5Vq0OCzjtLL0qs6A__&Key-Pair-Id=K6UGZS9ZTDSZM
1191e6e85ca53d399588dca53aeb32f6
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Text
The perceived value of just-in-time in-situ simulation training as a preparedness measure
for the perioperative care of COVID-19 patients
Jeffrey R. Keane, R.N.,1 Liana Zucco M.B.B.S.,2 Michael J. Chen B.S.,2 Nadav Levy, M.D.,2 Allison Hyatt, M.D.,2 Richard Pollard, M.D.,2 John D. Mitchell, M.D.,2 Satya Krishna Ramachandran, M.D.2
1. Unit Based Educator, Department of Nursing, Beth Israel Deaconess Medical Center, Boston, Massachusetts
2. Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Introduction
•
•
•
Training of redesigned perioperative workflows was urgently required due to COVID-19 pandemic.
Just-in-time (JIT) training is known to promote confidence in specific tasks.
COVID-19 Training was set up and delivered via JIT, in-situ simulation, team training.
Results
•
Up to 12 sims run per day over 3 weeks, through March-April 2020.
•
Trained 428 BILH perioperative staff members, across multiple sites.
•
Survey responses (n=110) revealed the following regarding all 4 simulation stations:
Methods: Implementation of Training
•
•
•
•
JIT in-situ simulation stations focused on minimizing viral exposure & transmission risk [Fig. 1].
Core group of faculty trained to run simulations in vacant OR’s.
Single page checklists created as cognitive aids.
Training delivered throughout Beth Israel Lahey Health Network (BILH) across disciplines.
(anesthesia, surgery, nursing, technicians) [Fig. 2].
Daily feedback & debriefing from faculty allowed for iterative changes to SOP’s & sims.
•
•
•
•
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Methods: Assessment of Training
•
Post simulation training surveys (Likert scale and free text) administered via email & QR code to assess
knowledge & comfort of COVID protocols, pre vs. post-simulation, and belief of impact on practice.
March-August 2020: reviewed anonymized HCW infection rates amongst perioperative staff and
compliance with COVID-19 protocols for COVID cases in the OR.
•
A
Knowledge of and comfort in adopting new workflows increased post-sim
(all p-values < 0.001; all means increased by ≥ 1.2 points on a 5-point Likert scale).
> 90% of respondents agreed or strongly agreed that this training would impact their future practice.
Free text responses appreciated timeliness of training, hands-on nature and inter-professional collaboration.
Constructive feedback through facilitated iterative changes to training and organizational SOP's.
95% compliance with COVID precautions in perioperative setting (121 of 127 cases through March – August 2020).
Network’s perioperative HCW test positive rate was < 1% (March – August 2020).
B
62% 65%60%64%
31%
25%
0% 0% 0% 0%
Strongly
Disagree
0% 1% 0% 0%
Disagree
35% 33%
7% 9% 6% 4%
Neutral
Agree
Strongly Agree
Belief that the simulation will create an impact on their clinical practice
Sim A - Pre-op Huddle (n=90)
Sim C - ICU Transfer (n=104)
C
D
Figure 1: JIT in-situ simulation training stations.
A: Pre-op huddle & OR set up for COVID-19 case.
B: Donning & doffing PPE.
C: Transfer of a COVID-19 patient from the ICU to the OR.
D: Airway management with enhanced infection control measures.
Figure 2: Schematic representation of the simulation
implementation team and framework. The core development
team (blue) trained the faculty trainers (grey)—who in turn
trained the rest of our network’s inter-professional perioperative
staff (green). Daily feedback was obtained from participants and
faculty trainers following each simulation, and regular updates
on changes to materials or SOPs were communicated through
faculty trainers or directly to staff members.
All of our up-to-date
COVID-19 perioperative
resources are available
online by scanning QR code:
(Includes resources on OB / GI / IR and more)
”Simulations provided an
opportunity to hear about the most
up-to-date protocol/policy changes,
and also about complaints."
Figure 3: Survey
results for perceived
impact of JIT
simulation training
on clinical practice.
Results expressed as
percentage of
responses for each
simulation drill.
X-axis represents a
5-point Likert scale.
Sim B - Don & Doff PPE (n=103)
Sim D - Airway Management (n=83)
"It really helps the nursing staff in
preparing to care for these patients
and increases communication
between the disciplines."
"Simulation got you thinking about
the issues in dealing with a COVID19 patient, and helped you learn
from others' trial and errors."
Discussion:
•
In context of COVID-19 and personal risk to HCW’s, we speculate “hunger for information” and
•
increased anxiety about a lack of knowledge on viral exposure risk & transmission served as drivers for
change.
This method of training facilitated “error proofing” of our newly designed workflow;
on-site observations, daily feedback and survey responses from participants triggered iterative
changes
to help refine our COVID-19 perioperative workflow.
Conclusions:
•
JIT in-situ simulation training is not only an effective education method in preparing our perioperative
HCW’s for COVID, but also an effective way to implement updates to perioperative workflows. Training
was highly regarded by participants, we observed high precaution compliance, and low test-positive
rate.
QR Code to
view online
�
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jeffrey R. Keane (<a href="mailto:jkeane1@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">jkeane1@bidmc.harvard.edu</a>)
Project Team
Jeffrey R. Keane
Liana Zucco
Michael J. Chen
Nadav Levy
Alison Hyatt
Richard Pollard
John D. Mitchell
Satya Krishna Ramachandran
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Anesthesia, Critical Care and Pain Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
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Title
A name given to the resource
The Perceived Value of Just-In-Time In-Situ Simulation Training as a Preparedness Measure for the Perioperative Care of COVID-19 Patients
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3e5c68ecd9057853b7833000d572b910.pdf?Expires=1712793600&Signature=AuRvElrGCs-WD8EOVmxd9B2lnYIhg1-HkGDrcvmu%7ETjBfUiqj6j9EyRPHQXWVThWXtKFIXoaMi%7EXrcSVPgxxrGscp3ZMjWFaQGb8T-FNPTrhN-D3wwGgwAsUqA2ETPMnzlTiYLOa-S3ClU6a257LS5qWiyeMfnZXOTRNIhkc4LpD0ezI%7E5ILDJqQFgqFTC76aKIv3KabC4Wr%7EwzJoSt22ymRfucbsdBJyAAUxle9MMDdEPLnCl7ecYvXO02Gh68I0yduxufELkJFvRUFUSJk9xrLvRjHFfncN1zanCaIrw02-1ivR9fUH4ZG3xNZaKZiz5hil7WzBf08b4HEVpz2HQ__&Key-Pair-Id=K6UGZS9ZTDSZM
b090ba29bfef97a2ac7b5dcce2071a9f
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Text
Inpatient Rehab Services’ Response to COVID-19 Pandemic
Brigitte Greenstein, OT, OTD
Margaret Walkup, PT, DPT
Beth Israel Deaconess Medical Center
Introduction
With the onset of the COVID-19
pandemic, the rehabilitation services
team had to adapt to the changes in
patient caseload, visitor policy, and
infectious disease guidelines. This
poster aims to describe the process
changes and outcomes that the rehab
department implemented during the
pandemic.
The motivations for our process
changes included:
- Minimizing the risk of transmission to
ourselves, families, coworkers, patients
- Maintaining a high standard of patient
care
- Maintaining a supportive atmosphere
to reduce burn out amongst our
colleagues
- Learning about COVID-19, how it
spreads, and the long term effects on
function and cognition
- Patient preference for discharge home
over discharge to rehab given the higher
COVID-19 infection risk
Process Changes
Minimizing risk of transmission:
- Implementation of staggered start times
- Creation of a virtual huddle board
- Day neutral staffing split into two teams
- Identification of COVID OT/PT
- Purchase of portable stair for in-room use
- Creation of patient fact sheets about energy conservation,
staying active while in the hospital, and PICS
- Minimized 1:1 time with patients by calling into their rooms to
schedule visits and obtain social history
- Bundling tasks to reduce need for other care providers to enter room
Clinical resources:
- Team leaders summarized up to date literature about COVID-19 and implications
for rehab
- Clinical guidelines were developed to assist with decision making regarding timing
of OT/PT interventions
- Weekly case discussions to debrief and educate
- Redeployed per diem and outpatient staff
- Safe Patient Handling team’s role in proning team
- Disaster documentation
Discharge planning:
- Use of technology to facilitate family trainings during periods of limited visitation
- Assisted in identifying candidates for transfer to NEBH and Boston Hope to
facilitate discharge and throughput
- Increased the frequency of OT/PT visits to promote d/c home rather than rehab
when able
Staff comradery:
- Created homeward bound board as a visual representation of patients that rehab
services helped discharge home
- Created a pool of therapists to rotate in COVID units
- Runner shifts to support nursing staff
- Wellness rounds, including group yoga
Outcomes
- Continued use of virtual huddle board
- Development of COVID-19 Rehab
Intranet that includes fact sheets and up
to date clinical information
- Ongoing use of the portable stair
- Streamlined documentation
Conclusion
Rehab Services was able to adapt to
patient specific needs during the
COVID-19 pandemic, while maintaining
quality care, that continue to be utilized
to this day.
In the event of another pandemic,
Rehab Services now has structures in
place to improve communication with
patients, families, and staff, while
keeping transmission risk low.
Acknowledgements
We would like to thank all of our rehab
colleagues who worked tirelessly
throughout the pandemic to provide
quality patient care.
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
<p>Brigette Greenstein (<a href="mailto:bgreenst@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">bgreenst@bidmc.harvard.edu</a>)<br />Margaret Walkup (<a href="mailto:mwalkup@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mwalkup@bidmc.harvard.edu</a>)</p>
Project Team
Brigette Greenstein
Margaret Walkup
Katelyn Campbell
Brian Mcdonnell
Shannon Stillwell
Department
Any departments listed on the poster or identified in the spreadsheet.
Rehabilitation Services
Occupational Therapy
Physical Therapy
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
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Title
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Inpatient Rehab Services' Response to COVID-19 Pandemic
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Patient and Family-Centeredness
Safety
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/6a205b835c16ea9cf363855702522aba.pdf?Expires=1712793600&Signature=hRsNiX0SvumQps7Xo4Fv5x1GV41tmv6lKWS7ogI0KIedgnhOFnblZMtmOmu%7E40TdCZfs00%7E6OPMH5RX0xmKmkrHHPfxz%7ERDo3MYgLdh%7Epn5bky-18WgGBYtVGHHluqN9E88U9LcWKxwKbRITqJEhobreThzpvo0rhSJwB8MuGFzqh5Pz4Kiba86ayG1R3roY8%7E35xqgDupdrGIjynPJEEpqK20Du8t8xqTseNH8acAyr10bUaW-VxJ2Kn7hdLII87TeYsp3EuLKgGFoz351xQiqE4sp3i700l9nDEUj2QOFu%7EpqNhW8jnsEJ63ItZt52Yk-PMZAY8PjYIdvSrbxI8w__&Key-Pair-Id=K6UGZS9ZTDSZM
20257a05ba80a7fd75fdd4146658dc74
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Doubling ICU Capacity by Surging onto Med Surg Units during the COVID- 19 Pandemic
Sharon C. O ’Donoghue, DNP, RN, Nurse Specialist, Barbara Donovan, MSN, RN, Nurse Specialist, Joanna Anderson, BSN, RN, CCRN, CNRN, Jane Foley, DNP, RN, Associate Chief Nurse, Jean
Gillis, MSN, RN, Nurse Specialist, Kimberly Maloof, MSN, RN, Nurse Specialist, Andrea Milano, MSN, RN, CCRN, CMC, Nurse Specialist, John Whitlock, MS, RN, Nurse Specialist, Susan DeSantoMadeya, PhD, RN, FAAN; Weyker Chair for Palliative Care/Associate Professor Nurse Scientist
The Team
Introduction/Problem
•
•
•
•
•
•
•
As COVID-19 was sweeping through the nation, Beth Israel Deaconess Medical Center (BIDMC) in Boston,
was preparing for a projected influx of critically ill patients in need of hospitalization
While it was anticipated that workflow would need to change, the full impact of the pandemic for the medical
center was unknown, causing increased uncertainty.
It rapidly became apparent that a plan for the arrival of highly infectious critically ill patients, as well as a
strategy for adequate staffing, protecting employees and assuring the public that this could be managed
successfully, was needed.
A hospital’s response to a large-scale event is greatly impacted by the ability to surge, and depending on the
type of threat, to maintain a sustained response. Planning for alternate critical care space has many
challenges, the need for a hospital to surge critically ill patients and care for them outside the ICU footprint is
referred to as an ICU surge. To identify surge capacity, an organization must first consider the type of event to
appropriately plan resources.
An epidemic surge drill, conducted at BIDMC in 2012, served as a guide in planning for the COVID-19
pandemic.
The principles of Crisis Standards of Care and a Hospital Incident Command Structure (HICS) were used to
clearly define roles, open lines of communication and inform our surge plan.
Preparation began by collaborating with multidisciplinary groups to acquire the most appropriate space,
adequate supplies, and identify and train staff.
Sharon C. O ’Donoghue, DNP, RN, Nurse Specialist, Barbara Donovan, MSN, RN, Nurse Specialist,,
Joanna Anderson, BSN, RN, CCRN, CNRN, Jane Foley, DNP, RN, Associate Chief Nurse., Jean Gillis,
MSN, RN, Nurse Specialist, Trauma/Surgical Intensive Care Unit, Kimberly Maloof, MSN, RN, Nurse
Specialist, Andrea Milano, MSN, RN, CCRN, CMC, Nurse Specialist, John Whitlock, MS, RN, Nurse
Specialist, Susan DeSanto-Madeya, PhD, RN, FAAN; Weyker Chair for Palliative Care/Associate
Professor Nurse Scientist
The Interventions
Aim/Goal
• An ICU Surge Planning Committee was convened and served as a subgroup of HICS.
• At the first planning committee meeting, a walkthrough of all units identified as potential surge spaces
was completed, and specific units were chosen to best meet the surge needs.
• Issues discussed were unit layout, proximity to existing ICUs, ability to close doors, and ventilator and
hemodynamic monitoring capabilities.
• The planning phase began in February, well before it was needed.
• The leadership team was informed by HICS that the trigger to escalate and open the surge areas
would be when ICU capacity reached 70 patients.
• Once this occurred, there was a twelve-hour window given to open the surge areas.
Teams were formed to identify the necessary resources to expand the ICU environment quickly and efficiently.
Educational training was developed for redeployed staff.
Shadowing experiences prior to the actual surge were extremely valuable.
Having NS support with Just in Time training and twice daily huddles to update staff on current PPE, any policy or
supply updates during this rapidly changing environment were highly valued by the staff.
ICU surge spaces varied from Post Anesthesia Care Unit (PACU) to 2 Med Surg (MS) Units both RB6 and RB7 .
36 bed MS unit was converted to a 36 bed ICU.
At the surge peak, 34 ICU level patients on RB 7 were being cared for with team nursing with both ICU and MS
nurses caring for a patient
Results/Progress to Date
•
•
•
•
•
BIDMC experienced the largest surge of ICU patients within a hospital system in the state of Massachusetts.
ICU capacity was expanded by 93% from 77 to 149 beds; and the surge was maintained for approximately 9
weeks.
Planning for the surge of critically ill patients required a thoughtful, collaborative approach. The preparation
phase was an important time where teams were formed to identify necessary resources in order to quickly and
efficiently expand the ICU environment.
Educational training including shadow experiences prior to the actual surge were valuable. Ongoing staff
support and communication from nursing leadership was necessary to ensure safe, effective care for critically
ill patients in a new and dynamic environment.
MS floors needed to have equipment and supplies for traditional ICU but we quickly learned the Covid patients
had specific supply needs such as each patient need 5-6 IV pumps, arterial lines, vents, pillows for proning
etc. and we were constantly readjusting our supplies to keep up with the demand
For more information, contact:
Barbara Donovan RN MSN, Nurse Specialist, bcdonova@bidmc.harvard.edu
�Doubling ICU Capacity by Surging onto Med Surg Units during the COVID- 19 Pandemic
Sharon C. O ’Donoghue, DNP, RN, Nurse Specialist, Barbara Donovan, MSN, RN, Nurse Specialist,, Joanna Anderson, BSN, RN, CCRN, CNRN, Jane Foley, DNP, RN, Associate Chief Nurse.,
Jean Gillis, MSN, RN, Nurse Specialist, Trauma/Surgical Intensive Care Unit, Kimberly Maloof, MSN, RN, Nurse Specialist, Andrea Milano, MSN, RN, CCRN, CMC, Nurse Specialist, John
Whitlock, MS, RN, Nurse Specialist, Susan DeSanto-Madeya, PhD, RN, FAAN; Weyker Chair for Palliative Care/Associate Professor Nurse Scientist
1.
1
2
3
2.
3.
4.
More Results/Progress to Date
Windows were cut into doors to allow better
visibility of the patient
WOWs downloaded with Metavision™
outside the patient rooms allow a nurse
workstation in proximity to the patient room
Rolling PPE carts at the doorway
IV pumps were moved outside some rooms
with IV extension tubing used to run it under
the door
Both RB 6 and RB 7 were modified to allow the nurse to have close proximity to the patients and alarms as well as
best visualization of the patients
The ICU/MS nurse teams cared for 2 or 3 critically ill patients. The 2 nurse to 3 patient ratio was very stressful for the staff as
these patients could be critically ill and very unstable. Two resource nurses were staffed to make the assignments, deal with
staffing issues and support acuity. Staff was supported by ICU and MS nursing directors, MS and ICU NS and UBEs.
Lessons Learned
The ICU leadership team carefully chose patients who could transition to the newly built ICUs. Patients chosen were stable on
their ventilator settings, as well as pressor and sedation regimes. Initially, the plan was to admit all patients from the
Emergency Department (ED) to the original ICU spaces with the goal of stabilizing them before transfer to the newly developed
units. This was not always possible and there were times when patients were admitted directly from the ED to the surge units.
There were several issues with the MS space and steps were taken to improve workflow and the safety of the patients. Of the
36 beds, only 2 rooms had windows built into the doors and the nurses quickly identified this as a safety concern. Within two
days, windows were cut into all other doors by the maintenance department which allowed for visualization of the patients
Next Steps
•
•
The MS floor was divided into 4 pods which functioned as 4 ICUs with physician and nurse teams working
with RT and pharmacy support to care for these critically ill patients.
These maps were posted to assist staff to know locations of Omnicells, supplies and emergency equipment
Unfortunately we had to surge again in the fall of 2020. We recalled the ICU/MS nurse teams who had previous training and
were able to use the PACU for Covid negative ICU patients and use RB 7 for Covid positive patients.
We were very nimble reopening the surge space. We were able to open 2 pods on RB 7 and the PACU in a short amount of
time.
We have learned it is more difficult to close the surge space and maintain our ICU capacity in the original ICU footprint
For more information, contact:
Barbara Donovan RN MSN, Nurse Specialist, bcdonova@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Barbara Donovan (<a href="mailto:bcdonova@bidmc.harvard.edu">bcdonova@bidmc.harvard.edu</a>)
Project Team
Sharon C. O ’Donoghue
Barbara Donovan
Joanna Anderson
Jane Foley
Jean Gillis
Kimberly Maloof
Andrea Milano
John Whitlock
Susan DeSanto-Madeya
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
MedSurg Units
ICUs
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Doubling ICU Capacity by Surging onto Med Surg Units During the COVID-19 Pandemic
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/53452562af5b1b4e2be0a6f2a01f738e.pdf?Expires=1712793600&Signature=PQmYMvSrtygbKmKA12keMdN-9XO3-HIypQt-fQmbGllaVqciGtGais8%7EaCKmj3POny8nl2VeJiMJH3b1bSk%7EBx8ZZMQptym%7En9L0ZdFzBlXwnyzDSDTjcjtXNx%7EUEEv0ffLpRfibQGn953-CXuOzYlELEbHLg3sZ0RWaYYJRdgndCEuc9QnBew9T52VQQa5jiclBMzzpz8hwJzpr9OGoDBYtzDq9QGJdmW%7Ez-NW8JmskzF%7EDKosOEWFhgp7gnNZHtF34JNjL-QvsSPbVmse2luCM6Pm2TTZbSdZf%7EoA4axYLl7k-vnxkBgdKw-NZoJiXNxVseNkf18lz-vm11zVcAw__&Key-Pair-Id=K6UGZS9ZTDSZM
2a231b62089c47f4e60db3a741ba1e14
PDF Text
Text
COVID 19 Skin Manifestation in the Acute Care Setting
C. Culleton, A. Feinstein, M. Gunning, D. Loehner, M. Melina, M Norberg
Beth Israel Deaconess Medical Center, Boston, MA
Introduction/Problem
The Interventions
* March 2020 World Health Organization declared a global pandemic
* Massachusetts was one of the first states affected by COVID 19
* Skin impairments noted on COVID 19 patients evolved differently from Deep
Tissue Injury (DTI) despite similar appearance.
* COVID 19 skin impairments were identified on areas on the body that were not
on pressure points.
* Review of literature: dearth of data related to novel virus
* NPIAP white paper validated our suspicions that these skin manifestations were
a result of a systemic process . Patients had coagulopathies, multisystem
organ failure , hemodynamic instability
•
•
•
•
Prevent pressure injuries
Optimize nutrition
Meticulous local wound care
Safety for patients and staff
Wound care for COVID 19 patients was approached with a conservative manner honoring the principles
of topical therapy
Bundled Care: repositioning patients every 4 hours, decreasing amount of PPE used by staff,
decreasing exposure
Education: pictorial resources for pressure injury prevention, application of foam dressings and offloading techniques
A mobile cart for the proning team and ICU staff. This cart included a checklist and readily available
supplies
Alternate air mattresses from in-house distribution
Debridement avoided due to risk of bleeding; conservative topical therapy
Results/Progress to Date
Aim/Goals
The Team
Covid skin Manifestation: top down injury located on soft tissue , lacy appearance , intact and non-intact
skin with epidermal sloughing to reveal partial thickness skin loss. Lesions very friable
D. Loehner
A.Feinstein
C. Culleton
M. Gunning
M. Melina
M. Norberg
For more information, contact:
Donna Loehner RN BSN CWON Clincal Director Wound Ostomy Nursing Team
�COVID 19 Skin Manifestation in the Acute Care Setting
C. Culleton, A. Feinstein, M. Gunning, D. Loehner, M. Melina, M Norberg
Beth Israel Deaconess Medical Center, Boston, MA
More Results/Progress to Date
Impaired blood flow to epidermis due to COVID 19 systemic coagulopathies. Top down injury that can
lead to partial or full thickness skin loss.
Covid skin manifestations most commonly seen on lower extremities , hands, feet, trunk.
Lessons Learned
•
•
•
•
DTPI defined as injuries that can have both intact and non-intact skin with localized area of persistent non
blanching deep red maroon pigment change resulting from prolonged pressure and shearing forces. If
not reversed can evolve into unstageable PI
Tissue Injuries seen on Covid patients appeared as DTPI but were found to have a vascular etiology as
evidence by histological tissue analysis and are now classified as Covid Skin Manifestations
Patients that require proning cannot be placed on low air loss support surfaces, this is a
contraindication
Coagulopathy caused by the Covid -19 virus require a conservative approach to Wound Care, surgical
sharp debridement is to be avoided
Is it possible that not all DTPI's are from pressure but rather from systemic inflammatory conditions?
Next Steps
Education of Medical and Nursing staff on the etiology and management of Covid skin manifestations
Further exploration and research into whether Covid skin manifestations could be classified as Acute Skin
Failure and if so, is this applicable to other critical ill patient populations that develop skin impairments
Further investigation into the progression and deterioration of some Covid skin manifestation into full
thickness wounds
For more information, contact:
Donna Loehner RN BSN CWON Clinical Director Wound Ostomy Team
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Donna Loehner (<a href="mailto:dloehner@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">dloehner@bidmc.harvard.edu</a>)
Project Team
D. Loehner
A. Feinstein
C. Culleton
M. Gunning
M. Melina
M. Norberg
Department
Any departments listed on the poster or identified in the spreadsheet.
Wound Ostomy Nursing Team
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
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Title
A name given to the resource
COVID-19 Skin Manifestation in the Acute Care Setting
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4d0a1d14314fe0b450fa0bee22224cc9.pdf?Expires=1712793600&Signature=j6FHaYCQF1%7ExK5LSMGYNQ9DT66owFfldrCGMSsetFX-y9UiCgLyKASV2m4UQ3BiRZsr8bBawFH%7EIeG0FRJsWpb-s-yPX%7E3KU6M2NmeO4eKc-pAou%7EjDZEZnfPzgh5chkPXM5RxOCZngrOigoY2ifzFX9y3KbFNYRzhYNG80%7E6xRWJXFomyRw9cq9hLhPqE9UAuh-uxMpJD4zFKhEcA0dxWQ51HGsFRaXb7VozR-3-OtIXCF7avjdIvDUIZvCir3FecDKY7GMF-%7EVTa4gZoBQkxAaE8z7kQ7bmEs3U5ZrN5Lz%7Eq-6jX1x%7E1imCc9xXFcRmLbYPl-Pu9WWThnHwTYaKA__&Key-Pair-Id=K6UGZS9ZTDSZM
98e9e892dc3235754c30237015852f05
PDF Text
Text
Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
In February of 2020, our group purchasing organization announced concerns for supply chain disruptions
given the reliance on active pharmaceutical ingredient (API) production from China. Conversely, none of
the wholesale distributors were experiencing any supply disruptions and that they anticipated none.
Historic experience with high acuity influenza surges (2009, 2017) and natural disasters (Hurricane
Maria) lent perspective to the potential impact of manufacturing and disproportionate demand leading to
shortages. However, the trajectory of this yet to be defined global pandemic left Pharmacy Operations
and Clinical Management without a clear direction for anticipatory purchasing or a watch and wait
approach.
After weeks, medications of concern affected were agents thought to treat CoVID-19 (e.g.
hydroxychloroquine, azithromycin), and agents to treat the symptoms of CoVID-19 (e.g. respiratory
medications-inhalers, nebulizers).
As the pandemic intensified, agents to address the influx of intensive care admissions (e.g.,
vasopressors, sedatives, intravenous opioids, neuromuscular blockers) became on short supply. The
shortage list continued to expand faster than any other time period across multiple categories threatening
to interrupt patient care.
Aim/Goal
To balance unclear and fast evolving demand with supply chain availability, fiscal responsibility, clinical
evidence, and avoiding a hoarding process, to avoid negative consequences in patients. There are no
available benchmarks for shortages other than avoiding stockouts, implementing therapeutic
substitutions and forestalling negative clinical outcomes.
The Team
John Hrenko, PharmD
Operations Supervisor
Gordon Hubbard
Purchasing Manage
Jamie Levash RN
Project Manager
Margaret Stephan MS
Chief Pharmacy Officer
Ifeoma Eche, PharmD
Clinical Manager
Howard Seth Gold, MD
Clinical Director
Julius Yang, MD
Clinical Director
Christopher McCoy, PharmD Clinical Manager
Department of Pharmacy
Department of Pharmacy
Health Care Quality
Department of Pharmacy
Department of Pharmacy
Health Care Quality, Infectious Diseases
Health Care Quality
Department of Pharmacy
Given the escalation and dynamic nature of supply chain disruptions daily huddles and communications were
enlisted,
Purchasing and Pharmacy Operations Administration continuously monitored supply chain announcements
from multiple sources, the group purchasing organization, manufacturers, wholesalers multiple times a day.
Purchasing sought out alternate suppliers and allocation methods to order/purchase items in high demand
continuously.
Pharmacy Operations used tactics including centralization of product supply, alternative route selection.
Clinical Pharmacy Managers worked with Infectious Diseases/Antimicrobial Stewardship to investigate and
reported out guidance relative to CoVID 19 therapeutics (e.g. high demand for azithromycin and
hydroxychloroquine). Alternate dosing strategies and algorithms for pain management, sedation and
neuromuscular blockade were created to standardize practice.
Invocation of the Drug Shortage Task Force including Health Care Quality was used to prioritize care, build
consensus with thought leaders and experts and devise algorithms and protocols.
A continuous modification of Provider Order Entry clinical decision support was designed and implemented to
guide best care and avoid shortages
Detailed interventions
Identify the key medications to
treat the complications of CoVID
19 infection.
• Dypsnea/Pneumonia
• Inhalers/nebs
• Antitussives
• Expectorants
• Sepsis
• Vasopressors
• Sedatives
• Antibiotics
• Analgesics
• Supportive meds
• Neuromucscular
Blockers
• Experimental CoVID tx
• Antibiotics
• Antivirals
Drugs completely out at the manufacturer and wholesaler level
Respiratory
Albuterol Inhaler
Albuterol Neb
Budesonide NEB
Epoprostenol IV
Ipratropium Bromide Inhaler
Ipratropium Bromide Neb
Tiotropium inhaler
Electrolytes
Calcium Gluconate IV
Magnesium Sulfate IV
Vasopressors
EPINEPHrine IV
NORepinephrine IV
Phenylephrine IV
Vasopressin IV
Intensive Care Unit Supportive
Artificial Tears
Chlorhexidine Gluconate PO
Sodium Bicarbonate IV
Sedatives
Dexmedetomidine IV
Ketamine IV
Midazolam IV
Propofol IV
Antibiotics
CefePIME IV
CefTAZidime IV
CefTRIAXone IV
Piperacillin-Tazobactam IV
Vancomycin IV
CoVID experimental therapeutics
Azithromycin IV
Azithromycin PO
Chloroquine PO
Cobicistat PO
Darunavir PO
Doxycycline PO
Doxycycline IV
Hydroxychloroquine PO
Lopinavir-Ritonavir PO
Neuromuscular Blockers
Cisatracurium Besylate IV
Etomidate IV
Rocuronium IV
Analgesics
Symptom Care
Benzonatate PO
GuaiFENesin PO
Fentanyl IV
HYDROmorphone IV
GuaiFENesin-Dextromethorphan PO
Ondansetron IV
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy .
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Therapeutic specific
demand and utilization
during surge 1 & 2.
Introduction of a
Performance Manager View
Overarching Planning and Execution detailed for our team
Continuous
monitoring of
demand and
retrospective
lookbacks:
Antibiotic demand during the first surge of 3 months dwarfed antibiotic use for
years prior and patients with CoVID were 10x more likely to receive antibiotics.
Continuous shifts directed by our team were necessary to keep supply.
Tracking and movement of key meds
with grading of next phase readiness.
• Par levels needed to be adjusted to
the new normal for daily/monthly
utilization
• A safety stock to get through
national shortages was required
but had to balance fiscal
responsibility and good global
citizenship (e.g. no hoarding)
• Omnicell (floor supply) had to be
readjusted to meet new floor
demands and centralization.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Situational awareness and community
building
Standard processes for ordering preparing
and administering meds all required
reframing across disciplines
Example of adjustment to steep demand
curves through therapeutic substitutions, in
this case from IV to PO for sedativeswithdrawal meds.
Example communications to all Hospital Staff
Early pandemic guidance suggested that all
items be disinfected to protect staff
In order to rein in the reflexive use of
agents thought to aid in treatment of the
infection given short supply and
prophylactic use.
Inhalers became in such short supply but critical
to care of all inpatients
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Pharmaceutical Supply Chain Management before, during and after the inpatient CoVID 19 pandemic surge(s)
John Hrenko,. Gordon Hubbard. Jaime Levash. Margaret Stephan, Ifeoma Eche, Howard Seth Gold, Julius Yang, Christopher McCoy
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
More Results/Progress to Date
Drug substitutions were necessary but required
education and communication.
Drug Shortage Task Force Prioritization Schemes
Example communications and clinical therapeutic
summaries
Cisatracurium outages
Midazolam critical lows
Lessons Learned
Fentanyl Mitigation
Therapeutic demand and supply chain interruption is nearly impossible to predict during a global pandemic
Interdisciplinary involvement and broad communications are essential to keep available supply and ensure public health safety
Time required to address all the clinical decision making, inventory control and supply allocation is more than 50% of dedicated
time.
Next Steps
Utilize similar tactics for management of acute shortages early with engagement of therapeutic area leads, inventory tracking
and demand curves.
Apply modeling for network engagement and resource sharing.
Utilize global facing platforms like PowerBI through Performance Manager.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
John Hrenko
Gordon Hubbard
Jamie Levash
Margaret Stephan
Ifeoma Eche
Howard Seth Gold
Julius Yang
Christopher McCoy
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Healthcare Quality and Patient Safety
Infectious Diseases
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pharmaceutical Supply Chain Management Before, During and After the Inpatient CoVID 19 Pandemic Surge(s)
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/8c3cf010b56fccf6495e21fb86001593.pdf?Expires=1712793600&Signature=dWn0Owc6u0s-eDFvDIE3k52Ot-3MxxNUmRvePm9cY%7EjnBFQ0NoirZTQiHpJDtSVAidvdwqRIlsaZFsDAky7i7m6LBESug32e0LQcoB0lKfgyYwYVHWWrhO4OxzS69s3pbIFZ%7Er1dnq%7EAFkGORedHAdfdHRK14c15PHQlVtgQO32ZPxZwaOIwix6wnmIestfMGtXccGPAMOipiHGVuc7sBnLZNmrcSM51JpRSKBFTiWOqclqq6hS7d20fWolvoOWAeGYmA5tMHVh5uPlDQov1m-z6rq4LRfaUZuZCJRmPtEKMLuWeIPTgNUwyvAn%7EzUPVp%7EmCTJn1GHWOiYv-Xq5uww__&Key-Pair-Id=K6UGZS9ZTDSZM
39171dfad4e8ec20a27153eae4f10b9e
PDF Text
Text
Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
The Interventions
Introduction/Problem
With the impending pandemic and its unclear impact, we convened a multidisciplinary workgroup across
Pharmacy, Infectious Diseases, Research, Transplant, Hematologic Malignancy, Critical Care and Health
Care Quality and others to begin to plot out a treatment guideline for CoVID-19.
The unknowns were many given the lack of approved treatments, the lack of peer reviewed published
literature and unclear trajectory for the breadth and depth of care at our institution.
The need for a rapid response and clear guidance became increasingly pressured during the first surge as
our census for those infected went from 3 to 192 from March to April 2020 with a high percentage of patients
requiring ICU level care and many remaining here for weeks.
Sources of data were limited to a World Health Organization outline, preprints from China and Italy and basic
science reviews of agents thought to have antiviral activity.
Early guidance were often completely refuted by well controlled trials, e.g. recommendation to given empiric
antibiotics to all patients with SARI, avoidance of systemic corticosteroids.
Over 273 medication shortages were making broad treatment recommendations difficult.
Active research protocols had to be introduced to promote systematic exploration
Aim/Goal
To provide a central and locally balanced resource for clinicians for the treatment of CoVID-19 bifurcated by
disease severity and predictors for advanced disease based on an ever evolving evidence base.
To grade therapeutic modalities and frame experimental therapies with risk considerations and newly
launched local research.
The Team
Roger Shapiro, MD
Attending Physician-HIV researcher
Katy Stephenson, MD
Attending Physician-Viral Vaccine researcher
Ryan Chapin, PharmD
Clinical Specialist- Infectious Diseases
Sabrina Tan, MD
Attending Physician- Viral Researcher
Margaret Hayes, MD
Attending Physician- Critical Care Director
Howard Seth Gold, MD
Medical Director-Antimicrobial Stewardship
Christopher McCoy, PharmD Clinical Manager- Infectious Diseases
CoVID 19 Treatment Collaborative
Infectious Diseases
Infectious Diseases
Pharmacy
Infectious Diseases
Critical Care Medicine
Health Care Quality, Infectious Diseases
Pharmacy
Built a multidisciplinary team with incorporation of the network and representation from key clinical areas
Developed a review process for preprints through MedrxIV, national guidelines (NIH, IDSA)
Scribed a treatment algorithm by severity of disease presentation.
Continuously evaluated and incorporated best practice for collection and interpretation of biomarkers and
laboratory values as well as comorbidities for risk stratification
Reviewed investigational therapeutics for linkage to local research studies (e.g., remdesivir, favipiravir)
Researched and provided dosing, drug interaction, screening and place in therapy guidance for all agents
Facilitated weekly data/literature summary meetings across a BILH network collaborative to build consensus for
guideline changes.
Reviewed drug shortage updates to alter treatment guidance toward a prioritization scheme
Directed restrictive criteria/clinical provider order entry guidance for therapeutic agents to promote safe and
evidence based utilization of scarce resources
Results: Data Review
Early but
continuous
review of
prepublished,
published
and
guideline
data.
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Most basic outline created Feb 2020
Basic tenets from WHO and CDC
Ongoing trial of remdesivir
Weblink guidance for early therapeutics
From basic science to WHO guidance to
National guidelines
US Clinical trial
development and linkage
HIV Antiviral adaptive
research
Agents not recommended
Earliest treatment algorithm
incorporating a single experimental
agent
First iterative
multidisciplinary multisite
algorithm: March 20
Early investigational
Agents with unknown utility
Severity graded guidance
Lab and Imaging guidance
Risk analysis for progression
Special Populations
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
Late March 2020
Began populating an ever growing
annotated citation list
Held first in a series of
Network Meetings
April 2020
Invited content experts and leaders
across the BILH network to build the first
Network treatment algorithm
Introduced Nephrology research on
niacinamide and conditional framework
Expanded sections on
Immunomodulators
Worked with EP/Cardiology
to enhance guidance
evaluation of therapeutic
agents with QT prolongation
concern
Built links to ongoing trials to boost
enrollment
Tocilizumab guidance
Hydroxychloroquine utilization
Hydroxychloroquine +/- Azithromycin
Adverse Event Investigation
JAMA Cardiology Publication
Did quality review of local tocilizumab
utilization and infectious complications
Added more evidence based guidance
for patients who may benefit from IL-6
modulation
Linked ICU teams with ongoing IL6
modulation trial-sarilumab
Identified hydroxychloroquine and
azithromycin utilization as concerning
Removed darunavir-cobicistat from
therapeutic recommendations
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
April 2020
Anticoagulation Prophylaxis and
Treatment Guidelines
Convalescent Plasma considerations
added
Tocilizumab Plan
Tocilizumab shortage management
Remdesivir approved for
EUA utilization: need for
local guidance and
separation from clinical
May 2020
trials
National allocation was
small for MA hospitals
requiring prioritization
scheme
July 2020
Communications to staff regarding
remdesivir
June 2020
Network Remdesivir Experience
Exploration
Presented and added dexamethasone
to treatment guidance
Removed hydroxychloroquine and
azithromycin as treatment agents
Lack of HCQ benefit
Added additional sections on
culture based antibiotic
utilization with rapid tailoring
for negative cx
Based on study data, limited
treatment duration to 5 days
Identified population with
benefit with moderate 02
requirements
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and Progress
Milestones
July 2020
Baicitinib initial review
August 2020
October 2020
Convalescent Plasma considerations
clarified given Mayo closes enrollment
BIDMC local abx utilization
and collateral damage
review published
FDA opens Remdesivir to all inpatients
Concern about Bamlanivumab
launch
Remdesivir EUA ends: FDA
approved
November 2020
First CoVID monoclonal Ab
Approved via EUA process
Guidance prepared
Baricitinib EUA guidance prepared
Dec 2020
Resources turn towards vaccine
approvals and EUA rollout
Incorporation of NIH figures
Remdesivir EUA supplies dwindle
prompting network utilization review
% utilization growth
50%
45%
40%
35%
30%
25%
On hold for vaccine launch
20%
15%
10%
5%
0%
Despite high census, BIDMC has strict
control on remdesivir use
For more information, contact:
�Development of a living guidance document for the therapeutic evaluation and treatment of patients with CoVID-19
Christopher McCoy, Roger Shapiro, Katy Stephenson, Ryan Chapin, Sabrina Tan, Margaret Hayes, Howard Seth Gold.
Department of Pharmacy, Division of Infectious Diseases, Division of Health Care Quality, Beth Israel Deaconess Medical Center
Results and progress
Milestones
Ivermectin review
Jan 2021
Infographics for antibiotic overuse
Continued tocilizumab evidence evaluations REMAP-CAP redirecion
February – November 2021
Outpatient and Employee vaccine rollouts
Vaccine recommendations for immune compromised host
Third dose and half dose boosters launched
Monoclonal Antibodies reviewed and infusions begun in June 2021
Additional antibody combinations reviewed and added given variants of interest
Regulatory reports for EUA allocation established and submitted
Tocilizumab shortage addressed with introduction of baricitinib via EUA and other
mitigation processes
Vaccine AE warnings added to screening documents for selection
Lessons Learned
Therapeutic review and guidance for an entity and a pandemic not seen before requires significant human resources to vet
hundreds of citations and build consensus.
A network wide guideline posted to institution specific intranet sites to accommodate resources of size and demand is an
achievable goal with regularly scheduled meetings.
Version control and edits can be daunting
The process of review and utilization reports revealed the potential for reflexive prescribing
Next Steps
Continue network collaborations across the CoVID 19 trajectory, vaccines and preventive therapies.
Determine ways to communicate more broadly and efficiently
For more information, contact:
Christopher McCoy, PharmD cmccoy@bidmc.Harvard.edu Clinical Manager, Infectious Diseases Pharmacy, Antimicrobial Stewardship
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Christopher McCoy (<a href="mailto:cmccoy@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cmccoy@bidmc.harvard.edu</a>)
Project Team
Roger Shapiro
Katy Stephenson
Ryan Chapin
Sabrina Tan
Margaret Hayes
Howard Seth Gold
Christopher McCoy
COVID 19 Treatment Collaborative
Department
Any departments listed on the poster or identified in the spreadsheet.
Infectious Diseases
Pharmacy
Critical Care Medicine
Health Care Quality and Safety
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Development of a Living Guidance Document for the Therapeutic Evaluation and Treatment of Patients with COVID-19
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/e77164b53da3fa18ca9587ea3c0e065c.pdf?Expires=1712793600&Signature=e81apZEKzBdMnz-NAjnpzG1ueo%7Er8gwu6FvgsK-xfHMD0V7Hxb%7E1X7ZJbFaVGkRIBoJQ07uT340%7EZ7A%7EqKYUyDZOV-PZUBRKi3%7ECxHT4xhI74AjpTQezkVgKpODyDLQ2%7EEygFBDYvGg0nD70dzr7UU%7ElKjoFSbgKSk4hBu98mRBkXHOcRxNlPdmUjAWMkFv2bANoYqdm5vm8Rbt8HC1zC6TmhI3wVR3KfUQomPVs3G7AbgIzr%7EQHppaOIvW9hE5Ky1FfbVZ%7EpAdTdBM6N5gUm5phjvGBjSPV%7EuZx6G8gnCf5ZYGwodakoBjWpgUrsEAKaOKE8WrxPT96f%7E8QeCTneA__&Key-Pair-Id=K6UGZS9ZTDSZM
cd6a42c09a2967c2c4767321243d6398
PDF Text
Text
Large-Scale In House Production of Viral Transport Medium and 3’ N95 Mask Disinfection Using Universally Available Materials
VTM: Kenneth P Smith1,2 , Annie Cheng1, Amber Chopelas#1, Sarah DuBois-Coyne#1,3, Ikram Mezghani#4, Shade Rodriguez#1, Mustafa Talay#5, James E Kirby6,2 1Dept. Pathology, BIDMC, 2HMS, 3Depart.
Biochemistry, U MA Boston,4Dept, Surgery, BIDMC, 5Dept. Molecular & Cellular Biology, Harvard University, #Contributed equally. N95 Mask: Katelyn E. Zulauf,#a,b Alex B. Green,#a Alex N. Nguyen Ba,c
Tanush Jagdish,d,e Dvir Reif,f Robert Seeley,g Alana Dale,g and James E. Kirbyh; aDet. Pathology, BIDMC, bHMS, cDept. Organismic and Evolutionary Biology, Harvard University
dProgram for Systems, Synthetic, and Quantitative Biology, Harvard University, e Center for Computational and Integrative Biology, MGH, fDepart. Molecular and Cellular Biology, Harvard Univ., gEnvironmental
Health and Safety Department, BIDMC, h,6Corresponding author, #Contributed equally.
Viral Transport Medium (VTM) for SARS-CoV-2
diagnostic laboratory testing– NONE available!
N95 mask disinfection for reuse
SARS-CoV-2
Nine personnel in two isolated
VTM production teams
Sourced available pre-sterilized
medium (HBSS, FBS,
antibiotics), CDC VTM recipe
with added phenol red for visual
QC
MS2 phage – tougher
RNA virus surrogate
4000
per day
Sourced tubes from donors
around Boston (until commercial
supplies available)
Titering MS2 virus plaques
Tissue culture rooms in CLS6
(8 biosafety cabinets)
Liquid handling automation
KP Smith, PhD, with permission
Rock climbing tape (donated) to
prevent repetitive use injury
Accelerated stability testing
Arrenhius equation –
pharmaceutical approach
2 weeks to predict >4 month
room temperature outdate,
sterility, robust support of
SARS-CoV-2 RT-qPCR
Daily QC (each run/lot)
Ref: JCM. PMC7383539
12 member kit assembly team
(added 3-D printed swabs et al.)
in Leventhal Conference Room
>100,000 VTM
collection kits for all
of BILH. Production
March –June 2020,
used into fall of
2020.
Method
1. Add concentrated M2 RNA phage virus to mask.
2. Glass dish, 1/4 cup water, grocery store web
mesh, rubber band, microwave 3 minutes
3. Count phage plaques (number of viable virus
remaining) compared with no treatment control
1.
2.
3.
4.
5.
Ref: mBio. PMC7317796
>150,000 downloads
MS2 phage = norovirus >> tougher than
SARS-CoV-2
> 6log10 MS2 virus titer reduction.
Performed 20X without loss of N95 fit
or filtration
Battelle vaporized hydrogen peroxide
system: >$ 6 million, centralized
Microwave decontamination, point-ofuse, <$10 setup using existing
microwave
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
James E. Kirby <a href="mailto:">jekirby@bidmc.harvard.edu</a>
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Kenneth P Smith
Annie Cheng
Amber Chopelas
Sarah DuBois-Coyne
Ikram Mezghani
Shade Rodriguez
Mustafa Talay
James E Kirby
Department
Any departments listed on the poster or identified in the spreadsheet.
Pathology
Surgery
Environmental Health and Safety
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Title
A name given to the resource
Large-Scale In House Production of Viral Transport Medium and 3’ N95 Mask Disinfection Using Universally Available Materials
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
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Efficiency
Environmental Sustainability
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/fa25a1b499e04b708cc1845f8403343f.pdf?Expires=1712793600&Signature=e5k6VOgq92L9%7EyY5uYvvvo-iQN36SG0xlJjfLl1CB7t34I71ZjTQACMyOVOh-dDm6c9rAjPoM3CHwSD9WgVWE9nSPdZOvTbPH6UKoylfoH8hUcc8oDCBA0IoGpYEBMtUk2E60VMSHqvnXsVhWPMn29UUbzxj2psrEXx60OBHmPw17l4jzDP2a2LNDd%7E-EbMNYoovMVdcODVBtYijUnxjokBuqQdkxbGBq5afgWA7rhM2uX-22guMQ8IOpxQMsavd4WVHFX4qj4ubS2ieCHthqIudBkz6Qz0kriI9s1wjgkRdaepMjg8Mdp-dlHrkIKM15HlDsVVA0nI%7EceOtTzpeiw__&Key-Pair-Id=K6UGZS9ZTDSZM
41a1a2cd4c4c7d88a2f709035489dd3e
PDF Text
Text
Leveraging a Real-Time Spatiotemporal AI Model for Surgical Resident Training and Education With
Implications during Pandemic-Related Surgical Volume Changes
Yilun Zhang1, Emmett Goodman2, Chris Kennedy1, Jevin Clark1, Hao Wei Chen1, Maren Downing1, Jordan Bohnen1, Serena Yeung2, Gabriel Brat1
1. Beth Israel Deaconess Medical Center, Boston, MA; 2. Department of Biomedical Data Science, Stanford University, Stanford, CA
Introduction/Problem
The Intervention
The COVID-19 pandemic exposed the existing need for more opportunities to
provide real-time feedback for surgical skills for surgical residents.
Real-Time Spatiotemporal AI Model
Aim/Goal
To Provide Automated Classification of Surgical Skill and Incorporate
Real-Time Feedback
The Team
Gabriel Brat, MD, MPH
Serena Yeung, PhD
For more information, contact:
Ilonzo, Nicole, Issam Koleilat, Vivek Prakash, John Charitable, Karan Garg, Daniel Han, Peter Faries, and John Phair. 2021. “The Effect of
COVID-19 on Training and Case Volume of Vascular Surgery Trainees.” Vascular and Endovascular Surgery 55 (5): 429–33.
�More Results/Progress to Date
Towards Understanding Surgical Skill
From Understanding Surgical Technique...
For more information, contact:
�More Results/Progress to Date
Model for Implementation
PGY1
Lessons Learned
Baseline
Next Steps
N = 104
For more information, contact:
�More Results/Progress to Date
Model for Implementation
PGY1
Lessons Learned
Baseline
Work on economy of motion by:
Reduce distance traveled by needle
driver hand
PGY1.5
Work on economy of motion by:
Continue to reduce distance traveled by needle
driver hand but also that of suture hand
Conserve hand pose by reducing unnecessary
rotation
Next Steps
N = 104
For more information, contact:
�More Results/Progress to Date
Model for Implementation
PGY1
Lessons Learned
Baseline
Work on economy of motion by:
Reduce distance traveled by needle
driver hand
PGY1.5
Work on economy of motion by:
Continue to reduce distance traveled by needle
driver hand but also that of suture hand
Conserve hand pose by reducing unnecessary
rotation
PGY2
Next Steps
New Baseline! Pred: PGY 3
Focus on conserving suture hand pose by reducing
unnecessary pronation
N = 104
For more information, contact:
�More Results/Progress to Date
Model for Implementation
Lessons Learned
Surgical Residents Require More Feedback during Case Load Changes
PGY1
Baseline
Automated evaluation of surgical skill is possible
Work on economy of motion by:
Reduce distance traveled by needle
driver hand
Providing “Just in Time” feedback after engaging in a task increases retention
PGY1.5
More discrete levels of training could allow for better than a binary skill
classification
Work on economy of motion by:
Continue to reduce distance traveled by needle
driver hand but also that of suture hand
Conserve hand pose by reducing unnecessary
rotation
PGY2
Next Steps
Improve integration of automated and remote forms of real-time feedback
for surgical trainees
New Baseline! Pred: PGY 3
Potential for other situations whenever the training path could be disrupted
Encourage increased collaboration between institutions
Focus on conserving suture hand pose by reducing
unnecessary pronation
PGY3
N = 104
Thank you to the peri-operative staff, the Shapiro Clinical Center, and
the residents who helped make this possible!
For more information, contact:
Contact: gbrat@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Gabriel Brat (<a href="mailto:gbrat@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">gbrat@bidmc.harvard.edu</a>)
Project Team
Yilun Zhang
Emmett Goodman
Chris Kennedy
Jevin Clark
Hao Wei Chen
Maren Downing
Jordan Bohnen
Serena Yeung
Gabriel Brat
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Surgery
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Title
A name given to the resource
Leveraging a Real-Time Spatiotemporal AI Model for Surgical Resident Training and Education with Implications during Pandemic-Related Surgical Volume Changes
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/2261faa049a2d385ea1fddc15d803b0b.pdf?Expires=1712793600&Signature=NoqaHnwNflFtkChSRjCqzrRHuoljLhfVh5RfyGw7SsrCoOHbb60eh5QaafqHF8MQzhIUMChNuHP-e8X98%7EftiXWHyaBie-yf%7EcvYwzAF6y7TgQbOE9WN6Q5jFzj1ytbTecaUvee8UJQTvC4wgxuMB4qsS3sNRUhUVX5YY64bsXPlOC2iSI8t2Za9Un7J%7EuX8RHZLizaWpm1zSCMZFb0rOma0gWhwKxpwrzQ7S80amTbfZicYXLTxYNe3MD0Ckb79EAFzchNnHb7of%7EPfNWr5o%7Ed56a7sku%7EZTtTVlncIQlCKVFTnXUFsFNLN02J-qeqmlQBUQQUlqqHo51oKiOKA9g__&Key-Pair-Id=K6UGZS9ZTDSZM
24087c16fc1d0fc5b1c7dd73cc1715ad
PDF Text
Text
Use of Intrathecal Dexmedetomidine for Cesarean Analgesia
in Parturients with Opioid Use Disorder (OUD)
Sichao Xu, Lior Levy, JoAnn Jordan, Yunping Li and Philip Hess
Beth Israel Deaconess Medical Center, Boston.
Background:
• Cesarean analgesia in OUD patients is
challenging
• Some clinicians use IT morphine or IV PCA
for postop pain
• Spinal dexmedetomidine (IT DEX) has been
effective in some patients
Hypothesis
IT DEX would produce analgesia similar to
IT morphine or IV PCA
Primary outcome
Visual pain scores (VPS)
Secondary outcomes
Hydromorphone equivalent dose
Hypothermia, sedation
OUD (n=44)
IT Bupivacaine 11.25 mg
+ Fentanyl 25 mcg
High dose home
opioid (n= 26)
Low dose home
opioid (n= 18)
IT Morphine
(n=4)
IT Morphine
(n=13)
IT Dex (n=8)
IT Dex (n=1)
PCA (n=14)
PCA (n=4)
�Fig. 1 Visual pain scores (VPS) and
hydromorphone equivalent dose (HED) in
the PACU and over 36 hours post-cesarean.
Fig. 2 Rescue TAP/QL blocks in PACU
�KEY POINTS
Primary Outcome
• IT DEX:
Lowest VPS in the PACU with no difference afterward
Fewest patients required rescue blocks in the PACU.
Secondary Outcomes
• HED (24 hr) lowest with IT morphine
• No difference in HED between IT Dex and PCA groups
• IT DEX not associated with postoperative hypothermia or sedation
CONCLUSION
• IT dexmedetomidine has a profound, but short-lived analgesic effect
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Sichao Xu (<a href="mailto:sxu5@bidmc.harvard.edu">sxu5@bidmc.harvard.edu</a>)
Project Team
Sichao Xu
Lior Levy
JoAnn Jordan
Yunping Li
Philip Hess
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Labor and Delivery
Dublin Core
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Title
A name given to the resource
Use of Intrathecal Dexmedetomidine for Cesarean Analgesia
in Parturients with Opioid Use Disorder (OUD)
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/47d07ae0897abff317ec841a89f78ebb.pdf?Expires=1712793600&Signature=d05lXgLtDTlC6M%7EUKaj0loIxB6yYQcgyAV%7E3F1UOMbQqRS2yEukmrsmbyzYjhG7FOLh6HtXrKeRUXOEGeCzXqZft38tZrG4VBUOQrTwE0i75wAjgNSOHXWWh9S3wQKSTK9qcSI3Hmai0UCHNtw6pvJ%7Ehoe796rs8MOI50oJbP62WU18M08JIYAFCboVJtUl18bv6sDXrmMKdOoCoq7tR3nvDkeCLqE5SYMNKHq0WmjltWfEjfYvdRb7BXOCjf1jw9b1dAdFBSv6M5imiYnR%7EXs3BBflMmcvTvW0Z-CCS9wF51MFmjlVzbbd3hoiHZqKCrvKnN29GCWliE%7EIregd70w__&Key-Pair-Id=K6UGZS9ZTDSZM
983b2fde039858475cc30617371dfc59
PDF Text
Text
BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
Introduction/Problem
When the COVID-19 Pandemic began, obtaining essential supplies from existing supply chain channels
became an urgent challenge due to significant shortages in supplies. At the same time, there was an
influx of support from community volunteers and alternative manufacturers that needed and wanted to
pivot from their traditional products and apply a variety of technologies and skills to producing products in
response to COVID-19. The volume of innovations coming to the surface required a team and a process
to effectively catalogue, test, source, and ultimately add alternatively sourced products to supply chain for
purchasing.
Aim/Goal
The goal of this work was to alleviate the shortages of essential supplies that were in short supply during
the COVID-19 surges, and create processes to be more prepared with alternative supply changes for
subsequent pandemics or other major public health emergencies.
The Interventions
Coordinated BILH system-wide sourcing & testing of alternative PPE
Developed and implemented BILH evaluation algorithm for PPE sourcing
Provided business and legal guidance for alternative RT-PCR kit sourcing
Provided business and legal guidance for open source 3D printed swab project
Communicated BIDMC PPE needs to COVID-19 Massachusetts Manufacturing Emergency
Response Team (M-ERT)
Brought >20 alternatively sourced products into the BILH supply chain
Results/Progress to Date
The Team
Administrative Project Team
• Emilie Downing, BS; Director of Market Analytics & Intelligence, BILH
• Catherine Gill; Senior Research Administrator, BIDMC
• Andi Hernandez, BA; VP of Research Operations, BIDMC
• Olivia Potvin, PhD; Research Program Manager, BIDMC
• Gyongyi Szabo, MD, PhD; Chief Academic Officer, BIDMC and BILH
• Eleanor Torrey, MPH; Senior Project Manager, BIDMC
• Tod Woolf, PhD; Executive Director of Technology Ventures Office, BIDMC
Research, Clinical, and Administrative Contributors
• Ramy Arnaout, MD, DPhil; BIDMC
• Sana Ata, MD; Lahey Hospital
• Alana Dale, BA; BIDMC
• Abby Flam, MCP; BIDMC & Atrius Health
• Heung Bae Kim, MD; BCH
• James Kirby, MD; BIDMC
• Jeffrey Lamson, BS, RN; BIDMC
• Stanley Lewis, MD; BILH
• Chip McIntosh, NP, PhD; BILH
• Phillip Mears, MHA, JD; BILH
• Christopher Minette, MBA; BIDMC
• Peter Shorett, MPP; BILH
• Thomas Siepka, RPh, MS, FASHE; BIDMC
• James C. Weaver, PhD; Wyss
• Marten H. Wolckenhaar, MD; Lahey Hospital
• Sharon B. Wright, MD, MPH; BILH
• Mark Zeidel, MD; BIDMC
1. COVID -19 Innovation Hub. Alternative manufacturing and methods project categories:
1) PPE Products, 2) PPE Sterilization for Re-Use, 3) Ventilators (parts, repair and novel simplified
designs), 4) Assays (COVID PCR and serological assays), and 5) Therapeutics and Vaccines (discovery
research and clinical trials).
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
More Results/Progress to Date
2. Community Support Overview.
3. BILH Evaluation Algorithm for PPE Sourcing. The BILH COVID-19 Innovation Hub 1) organized the
flow of PPE donations, and had the PPE evaluated for suitability, and 2) consolidated requests and
sources of PPE from pivoted manufacturers and tracked which items could be cleared for use at BILH.
4. Covid-19 Diagnostics. 1) James Kirby at BIDMC quickly developed a Q-PCR assay with a local
company that was used early in the pandemic and other area hospitals for clinical diagnosis of COVID-19
when CDC tests were unavailable (not shown here). 2) A multidisciplinary team of experts led by Ramy
Arnaout at BIDMC collaborated with 3D printing companies and other Medical Centers to develop open
source 3D printable swabs used for COVID-19 testing (above).
5. Alternative N-95 Elastomeric Respirator from BCH/Wyss/BIDMC. This alternative respirator was
developed with readily available locally sourced filter modules and a 3D printed adaptor. The product was
found to be effective, but was not deployed as it was not NIOSH approved.
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Emilie Downing, BS, BILH and Tod Woolf, PhD, BIDMC
More Results/Progress to Date
6. Massachusetts Manufacturing Emergency Response Team (M-ERT). Mark Zeidel and Tod Woolf
communicated BIDMC PPE needs on weekly M-ERT conference calls. Our work with the Covid-19 MERT had an impact in Massachusetts and beyond, and the M-ERT has been cited by government officials
as a model for innovative manufacturing responses to emergencies.
8. Summary. Our Innovation Hub reviewed over 156 alternatively sourced items, with >20 items passing
the evaluations and being approved to enter the BILH supply chain. We have established work flows for
evaluating novel supply chains during future emergencies.
Lessons Learned
7. Alternative Manufacturing of Disposable Face Shields from Lacerta. James Weaver from the Wyss
Institute led this project (https://wyss.harvard.edu/news/seven-million-face-shields-and-counting/). These
masks were produced at very large scale (millions) by local manufacturer of food packaging (Lacerta).
We coordinated with environmental health at BIDMC to have these evaluated and they were added to the
BIDMC supply chain.
We learned that making products which require governmental approval is quite challenging, and
requires input from regulatory agencies, engineers, environmental safety and end users. Some
items, like face shields and ethanol hand sanitizer, were relatively easy to find alternative sources,
but complicated items like the specialized materials used in N-95 masks was much more difficult and
time consuming to obtain from alternative manufacturers.
For more information, contact:
Tod Woolf, PhD, Executive Director of Technology Ventures Office, twoolf@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tod Woolf <a href="mailto:%20">woolf@bidmc.harvard.edu</a>
Project Team
Emilie Downing
Catherine Gill
Andi Hernandez
Olivia Potvin
Gyongyi Szabo
Eleanor Torrey
Tod Woolf
Ramy Arnaout
Sana Ata
Alana Dale
Abby Flam
Heung Bae Kim
James Kirby
Jeffrey Lamson
Stanley Lewis
Chip McIntosh
Phillip Mears
Christopher Minette
Peter Shorett
Thomas Siepka
James C. Weaver
Marten H. Wolckenhaar
Sharon B. Wright
Mark Zeidel
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Tech Ventures
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Title
A name given to the resource
BILH Covid-19 Innovation Hub: Innovative COVID-19 Response Supplies from Novel Sources
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Efficiency
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/46667bf0ba7d16a0b0ca4b7d3fc67105.pdf?Expires=1712793600&Signature=noGyre2cykO0STGoaegBNNtA6V8qGnl5aB3zHzic196o7KoAIYHJHF0LoV9ZPFiEvnmaMVyJjr3smHHD3hpVDR2F4efaL40FVVbs95AjjOlaLwrV8shUIc1VQTn6gqd80etnV0mpLmEmLYCc3rMy0k8uL6ptDQeh3lDymLvAVOWgokg2nGoIyMzLz1DUT2XMIIopXTc%7EOC7TBRgT14ZTZyypEnBCIoDoyyHO6JU99%7EKUFpg7TFRwdfwtKVt%7E5pFOeZogYhYHRjt95%7E1KTtgem6eQNL2rM0qsvk8NzeoiWMolav%7EZUnal1IO5KGheLNRQDop8FSPL60fgSLJyVqdqkQ__&Key-Pair-Id=K6UGZS9ZTDSZM
a73135d6dd6939caa6a88e1a94e37e3e
PDF Text
Text
COVID-19 Staff Vaccine Clinics
#Thisismyshot
Allison Wang, Lori DeCosta, Mo Ortega, Liz Haftel
Results
Background
•
•
•
•
As COVID-19 became a worldwide pandemic, urgency
for a vaccine became paramount as hospitals were
overwhelmed
The COVID-19 vaccines were the first brand new
vaccines to be granted an Emergency Use Authorization
(EUA) in the USA
In conjunction w/ EUA approval, we rapidly planned &
setup COVID-19 vaccine clinics for staff while dealing
with widespread supply/staffing shortages
Multi-disciplinary effort w/ coordination across ~15
departments (see next slide for team)
Planning & Implementation
Logistics
• Hospital Incident Command System (HICS) Structure
enabled rapid collaboration & streamlined decision
making and authority
• Space- Vaccination clinic location needs & considerations
(i.e. Social distancing, observation space etc.)
• Prioritization Scheme – based on federal/state /BILH
guidelines
• Day of Clinic - Designed new workflow
& simulated to increase efficiency
Planning & Implementation (cont.)
Figure 10
Figure 2
Nov
2020
Figure 6
Shapiro 10 Flow &
Signage Walkthrough
Figure 5
12/1 12/2 12/3 12/4 12/5 12/6 12/7 12/8 12/9 12/10 12/11 12/12 12/13 12/14 12/15 12/16
Pfizer
Submits EUA
Pfizer EUA/DPH
Approval
Moderna
Submits EUA
•11/30 –
Planning kickoff
Combined
Clinics 2/15
Pfizer Shapiro 10
Clinic Go-Live
•Prioritization sent to managers
•COVAX testing & schedule build
•Clinical protocols
Scheduling
Open to Phase 1
12/28
Moderna Shapiro
3 Clinic Go-Live
Clinic
Simulation
Figure 3
Design Session
Figure 9
Figure 7
Figure 4
Figure 11
* Refer to figure appendix on slide 3
Feb/Mar
2021
Moderna EUA/
DPH Approval
Figure 1
Supply
• State & BILH allocation management & strategy
• Vaccines –medication storage/delivery process/prep, etc.
• Medical and non-medical supplies
IT Processes
• COVAX - Scheduling System – how to integrate systems
that didn’t talk to each other
• Agility -EOHS
Jan
2021
Outcomes
Figure 8
Figure 12
Staffing
• SOPs/ Standing Orders/ Reactions & Contraindications
• Training - vaccinators/observers/front desk staff/
manager
• Innovative use of Labor Pool
Communications
• Signage and media relations
• Staff outreach & education
• Interpreter services (iPad & multi-language docs.)
Continuous Improvement
Managing a Variety of Challenges & Barriers
• Day-to-day supply instability (i.e. supply allocations,
Walgreens extra doses etc.)
• Sourcing proper equipment (i.e. Ultra cold storage, 1
ml syringes, research space usage etc.)
• Phased vaccine rollout troubleshooting
• Collaboration across BILH as a NEW hospital system
Check & Adjust
• Frequent reassessment of operations as new approvals
and guidance was released
• Strategies to reduce or limit vaccine waste
• Continuously adjusted capacity to increase
appointment access for staff
• Open 2nd clinic/Combined clinics
Sustainment
• Patient clinics & inpatient vaccinations
• Vaccine hesitancy work
• DEI campaigns
• Partnership w/ Red Sox for vaccine clinics
• Boosters
Created By: Allison Wang
Last Updated: 10/28/2021
�COVID-19 Staff Vaccine Clinics
#Thisismyshot
Allison Wang, Lori DeCosta, Mo Ortega, Liz Haftel
Team Members
The Teams Who Made This Happen!
The Clinics
Collaborators for Poster
•
Allison Wang & Jasmine Cline-Bailey (I2 - Improvement
and Innovation)
•
Lori DeCosta (Clinical Nutrition)
•
Mo Ortega (EM - Emergency Management)
•
Peggy Stephan, Liz Haftel, Julie Lanza (Pharmacy)
•
Matt Rabesa (Employee Health Management)
•
Dr. Mary LaSalvia (HMFP)
Additional Key Departments
Larry Markson, Carolyn Conti, Jim Arrington, Venkat
Jegadeesan & Team (IS)
• Jarrod Dore & Team (Facilities)
• Buzzy Abrha, Gordon Howard, Jinkyu Lee, & Vaccinators
(Pharmacy)
• Kyle Franko (Communications)
• Sarah Moravick & Kristin O’Reilly (I2)
• Declan Carbery (EM)
• Bridgid Joseph (Emergency Procedures)
• Brian Bertrand & Eric Acevedo (Distribution)
• Lori Cunningham & Team (Human Resources)
• Paula Stering (Clinical Advisor)
• Dr. Ed Ullman (Medical Director Fenway Clinics)
• PCS & Retired Nurses
• HMFP
• Vaccinators
• ID
• EVS
• Food Services
• BILH
And so many more….!
•
Created By: Allison Wang
Last Updated: 10/28/2021
�Figure Appendix
Figures (1-12):
1.
Draft of an iteration of the vaccine clinic flow
2.
Draft of the vaccine clinic setup
3.
Phasing from Gov. Charlie Baker’s Massachusetts vaccine distribution plan
4.
Brainstorming from the Design session on clinic throughput scenarios
5.
Staff Member getting vaccinated
6.
Pharmacy technicians prepping vaccines
7.
Acting out an emergent scenario during the simulation of the clinic prior to opening
8.
Simulation scenarios used to practice and work through issues prior to opening
9.
Construction of Shapiro 3 Moderna Clinic
10.
Color coding of Pfizer vs. Moderna syringes to prepare for combined clinic
11. Progression
12.
through BILH Phases (Sarah Moravick Leadership Presentation 1/25/21)
Stats (Sarah Moravick Leadership Presentation 1/25/21)
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Allison Wang (<a href="mailto:aswang@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">aswang@bidmc.harvard.edu</a>)
Project Team
Allison Wang
Lori DeCosta
Mo Ortega
Liz Haftel
Peggy Stephan
Matt Rabesa
Jasmine Cline-Bailey
Julie Lanza
Mary LaSalvia
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Improvement and Innovation
Clinical Nutrition
Emergency Management
Pharmacy
Employee Health Management
HMFP
Information Systems
Facilities
Communications
Emergency Procedures
Distribution
Human Resources
Clinical Advisor
Fenway Clinics
Environmental Services
Food Services
BILH
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COVID-19 Staff Vaccine Clinics
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/4eb298bfa83e7f40ad45a140d7ab2244.pdf?Expires=1712793600&Signature=kxdDSV8fzzqxMjQhxCSiZN7w5cyJZ81tLRss-okLNkBjdF1RzfweG7KOuES4it5TQ-sJGeoB3DD66tockCWD%7E2-rJXHvhgVU7%7EhLtGVA3ssYfQnNWPPd8iNCcacHwgWqoSFKomyIiqN5YQWlx0OEmMLkos75Wadu5gAfTPy5qgVNJrYNhGIqPnLR2INfl1qL4EoWUaA2LXyeUc1b4wXC7gE1zZ6TXzL%7ERwy%7EHk6MZzWla5KCarFzpKR8vamsiNo3c33JEmysRfRpMGlgZZOVhLNTDCVG7JQRmIFRd58Nfd5tiiF4k6cEMDK4VWpG2F01tclkM08fmQcZjse93VIt1Q__&Key-Pair-Id=K6UGZS9ZTDSZM
ac4c93063ed59d0e037d552f9223ae8a
PDF Text
Text
Research Pharmacy in COVID-19
Introduction
Research Pharmacy :
A specialized area that facilitates the
conduct of clinical trials using research
medications in human subjects
Each campus has a Research
pharmacy
• West Campus:
Non-oncology trials, primarily
inpatient studies
Outpatient ambulatory clinics
• East Campus:
Both Oncology and Non-Oncology
trials
Ambulatory clinics
Clinical Research Center (CRC)
Research Pharmacy Responsibilities
To provide preliminary pharmacy review and approval prior to IRB submission:
•
Feasibility
•
Potential benefit outweighs risk to human subjects
•
Accuracy of application to protocol
Preparation and Dispensing:
•
•
•
•
Introduction
A typical clinical trial life-cycle (nonCOVID):
Pre-review prior to IRB submission
(3-5 business days)
Review during the IRB process
Preparation for activation/dispensing
(2 weeks post IRB approval)
Typical process (non-COVID-19):
A couple months from pre-review to
patient dispensing
During COVID: Average turnaround
time 24 hours for pre-review
Dispensing to patients in less than
a week (typically within 24 hours of
research medication receipt)
•
•
•
•
To facilitate research medication dispensing and accountability to ensure compliance with the
protocol and all applicable regulations, policies, and procedures
Protocols are dissected by the pharmacists for preparation and dispensation details
Guidelines are created prior to enrollment to ensure safe and accurate preparation and
dispensing for the entirety of the protocol
There is a USP <797> compliant cleanroom for preparation of sterile products including
Chemo/hazardous medications
Pharmacists create example order templates (POE) for the providers to use
Pharmacists build the protocol in the pharmacy system/POE
Provide prompt review of protocol amendments to ensure compliance throughout the study
Facilitate audits by sponsors and regulatory agencies
Inventory control :
•
Strict adherence to inventory control procedures
•
Internal ordering and receipt of supplies for each trial
•
Protocol built in Vestigo (inventory /accountability)
•
Inventory management to ensure adequate supplies for study subjects
•
Perpetual accountability (every vial/bottle/tablet)
•
Strict temperature monitoring for storage conditions
•
Internal destruction of expired/unused materials
Results
26 Therapeutic trials opened
Including:
Remdesivir (NCT04292899/NCT04292730
Sarilumab
Alteplase (NCT04357730)
Hydroxychloroquine (NCT04332991)
Leronlimab (NCT04347239)
Various platform studies
Compassionate use
119 patients (796 dipensings)
3 vaccine trials opened
(NCT04611802/NCT04436276)
181 patients (551 dispensings)
Conclusion
We are not done yet!
3 therapeutic trials still open
ACTIV-3 (NCT04501978)
HIBISCUS (NCT04860518)
ACTIV-2 (NCT04518410)
More in the pipeline
Additional vaccine trials in the pipeline
Research pharmacy team:
Heena Patel, manager
Non-oncology RPhs: James Arrico, Kim
Kocur, Melissa Sciola, Ayu Tesfaye
Oncology RPhs: Sneha Hunjan, Jill
Keough, Renee Manolian, Andrea Mark
Pharmacy Technicians: Frank Man, Brenda
Nguen, Mai Nguyen, Viviana Reyes
�
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Silverman Symposium
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An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Melissa Sciola (<a href="mailto:Msciola@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">Msciola@bidmc.harvard.edu</a>)
Project Team
Heena Patel
James Arrico
Kim Kocur
Melissa Sciola
Ayu Tesfaye
Sneha Hunjan
Jill Keough
Renee Manolian
Andrea Mark
Frank Man
Brenda Nguen
Mai Nguyen
Viviana Reyes
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Pharmacy Technicians
BIDMC Location
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BIDMC
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Research Pharmacy in COVID-19
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2021
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pdf
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17be930de2a04b14b812b000962ab16c
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Basic Research Response during the COVID-19 Pandemic
Andi Hernandez, Vice President, Tanya Santos, Director, and Kim Chun, Project Manager, Research Operations
Beth Israel Deaconess Medical Center
Introduction
In March 2020, the City of Boston declared COVID-19 a public health emergency.
Research Operations was tasked with safely shutting down basic and translational research labs
by instituting new operational protocols and best practices. Only essential research and
maintenance staff were allowed on-site and all non-essential research work was transitioned to
remote. In facilitating the Research shutdown, we recognized the potential in improving our
operational and communications plan for reopening the Research labs in June 2020.
Goal
Our overall goal was to effectively shut down and reopen basic and translational research labs
while ensuring the safety of all Research Employees and animals and regularly communicating
progress with the Research Community.
The Team
Leadership
Gyongyi Szabo, MD, PhD; Chief Academic
Officer, BIDMC and BILH
Andi Hernandez, Vice President, Research
Operations
Research Operations
Tanya Santos, Director, ResOps
Kim Chun, Project Manager, ResOps
Barbara Garibaldi, Director, ARF
Denise Glass, Assoc. Director, ARF
Mark Varhol, Lead Project Manager, ResFac
Lucero Vega, Sr. Project Manager, ResFac
Kim Tablante, Research Administration
Chris Botte, Academic Research Computing
Environmental Health & Safety
Kristin Piticco, Interim Director
Peter Schooling, Safety Officer
Rob Griffin, Biosafety Officer
Research Reopening Planning Committee
Al Charest, PhD, Research Safety
Committee Chair
Steven Balk, MD, PhD – Professor of
Medicine
Jack Lawler, PhD, Professor of Pathology
Leo Otterbein, PhD, Professor of Medicine,
IACUC Chair
Evan Rosen, MD, PhD, Principal Investigator
The Interventions
Interventions in preparation for Research Shutdown
Generated Lab Ramp-Down Checklist, Remote Access to Systems tools for Research Community
Work from Home Assessment/Staffing Survey distributed
Managed the process for research lab donations for Clinical Supply shortages
Managed Redeployment to COVID-19 clinical efforts
Delayed New Hires/Visa Processing
Kept abreast of changing NIH Grant Management guidelines
Continued on-site management/maintenance of labs by Research Facilities
Converted research lab space to Clinical COVID-19 testing and PPE reprocessing facilities
Interventions in preparation for Phased Research Reopening
Hosted Town Hall meetings regularly (2x per month from April 2020 to July 2020) to update Research
Community
Organized a Research Reopening Planning Committee comprised of members of leadership,
Research Operations, EH&S, and Research Community leaders
Discussed and Coordinated timing of Reopening with: BIDMC COVID-19 Command Center, Harvard
University Committee of Research Laboratory Re-Entry, Conference of Boston Teaching Hospitals
group & AAMC Dean’s group
Created a Reopening Survey for completion by the Research Community to obtain feedback about
their safety concerns with returning to the lab
Implemented the Section Chiefs Program to assist in COVID-19 Safety efforts during Reopening
Created the Research Reopening Resources Page on the BIDMC Portal
Created and implemented myPATH Return to Research Training for all returning staff and new
incoming staff during Phase I and Phase II
Produced Research tools: example: checklists, signage, and put engineering controls in place for
social distancing
Opened a direct e-mail line for Return-specific questions: researchreturn@bidmc.harvard.edu
For more information, contact:
Tanya Santos, Director, Research Operations: msantos3@bidmc.harvard.edu
�Basic Research Response during the COVID-19 Pandemic
Andi Hernandez, Vice President, Tanya Santos, Director, and Kim Chun, Project Manager, Research Operations
Beth Israel Deaconess Medical Center
Basic Research Shutdown Timeline
March 15
(Sunday)
Communication
from CAO re:
Shutdown
Preparations for
Shutdown
March 16
(Monday)
• COVID-19
Redeployment
• Animal Welfare
• Essential
Staffing
March 17
(Tuesday)
Guidelines and
Safety Protocols
created and
provided to
Research
Community
March 18
Wednesday
Results
• Staffing Survey Completed
• Remote Work Assess
Guidelines Distributed
•
~118 Labs Shutdown
by 5pm in 3 Research
Buildings
1. Basic Research labs and core facilities were shut down by 5:00pm on March 18, 2020. As shown by
the graphic above, Research was successful in shutting down labs within a 3-day period.
Basic Research Reopening Phased Approach
55 out of 99 Research
employees redeployed
Due to supply shortages,
Laboratory supplies/PPE
donated for clinical needs
Lab Spaces were made available for
COVID-Testing and Masking
Stations while not in use
3. During the Research shutdown, the Research Community contributed to BIDMC’s overall COVID-19
management effort by diverting personnel assistance, supplies, and lab spaces.
Section Chiefs have been identified for larger
open lab units on each floor/section. They are
responsible for coordinating and creating
schedules for shared equipment use and
common areas for eating/breaks as well as
addressing issues and concerns with COVID19 prevention processes.
COVID-19 Safety Officers are responsible for
reporting any concerns with processes within
the lab or shared spaces to Section Chiefs,
appropriately coordinating with the PI
2. Our phased reopening model for Research enables us to adjust on-site research/population density
phase by phase easily with as little disruption as possible. In June 2020, we entered Status Yellow
(Phase I) and after one month, we ramped up to Status Blue (Phase II). The triggers for our gradual
ramp up/down are guided by BIDMC and state and local response to any COVID-19 trends.
4. The Section Chiefs program (~35 individuals) significantly supported and contributed to the Research
Operations team’s effort to safely reopen basic research labs. The Section Chiefs were our “eyes” on the
research floors. They aided in enforcing safety best practices and communicating guidelines to
Researchers.
For more information, contact:
Tanya Santos, Director, Research Operations: msantos3@bidmc.harvard.edu
�Basic Research Response during the COVID-19 Pandemic
Andi Hernandez, Vice President, Tanya Santos, Director, and Kim Chun, Project Manager, Research Operations
Beth Israel Deaconess Medical Center
More Results
5. Throughout the shutdown and reopening period, Research Operations communicated regularly with
the Research Community via virtual Research Town Halls and by re-distributing BIDMC-wide e-mails to
the Research Community highlighting Research-specific instructions/relevance. Town Halls were
recorded and made available on the Portal to ensure everyone had access to the updates. Over the
course of this period, we also generated a number of tools and resources for our Researchers.
Lessons Learned
Researchers want to be heard and are willing to provide feedback
Efforts need to be coordinated with all key stakeholders in order for implementation of new guidelines
to be successful and met with little resistance
Research now has an emergency management contingency plan and a catalogue of tools available
that can be tailored to based on the severity of the situation
Research Operations opened more direct lines of communication & reach to our Research
Community through the implementation of the Section Chiefs program (in addition to our existing Lab
Safety Officer Program)
Next Steps
Continue to monitor/evaluate emergency management contingency plan
Improve tools and resources already available and connect these to the appropriate contingency
levels (See Results #2)
Re-enforce awareness of the available tools and resources contingency plans
Better utilize available resources to strengthen communications with Research Community (Portal,
use of pre-existing templates, distribution lists)
For more information, contact:
Tanya Santos, Director, Research Operations: msantos3@bidmc.harvard.edu
�
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tanya Santos (<a href="mailto:msantos3@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">msantos3@bidmc.harvard.edu</a>)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Gyongyi Szabo
Andi Hernandez
Tanya Santos
Kim Chun
Barbara Garibaldi
Denise Glass
Mark Varhol
Lucero Vega
Kim Tablante
Chris Botte
Kristin Piticco
Peter Schooling
Rob Griffin
Al Charest
Steven Balk
Jack Lawler
Leo Otterbein
Evan Rosen
Department
Any departments listed on the poster or identified in the spreadsheet.
Leadership
Research Operations
Environmental Health & Safety
Research Reopening
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Basic Research Response During the COVID-19 Pandemic
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
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https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/93c5a805a2c7d409d11fce186a16266a.pdf?Expires=1712793600&Signature=opX%7EGD--KmTMFGy8e4%7EsuQTNsRLtA27sT1CgIMXpCEHemBteh8c7NrGjspjCdyO%7EQQ6Z%7E8ufxfKw9BYTLUI5PfguUUl5SQh5QV-ud633dPuwk%7E9T5K-Lxf%7ErAoY5vMBZKayObcDLir9xQuiM8Wzolx6W35enaHoA-%7E1SLH2bzyzvfJwLrtIgcaDLFQt-zHsKqMwHm%7E2SoYclgEQdvGoJR8j%7EtdqsmDHxcInR-yKHlfGVNjaehUnvbu5Xuyvl9-jMyWTNCsBlB9%7EHn-gHKOCUw74HZYHwjVf%7E0BjVe--%7EQf8IjV8tGeV%7EDOwd4fMuAPEkiNs9clIz7wGWKUJrqgAV-w__&Key-Pair-Id=K6UGZS9ZTDSZM
45e2b6b7b407e27bbd58b2e7b8c8b5c2
PDF Text
Text
CLOSED: Closing Loops by Operationalizing Systems Engineering and Design
Talya Salant1, James Benneyan2, Nicole Nehls2, Mark Aronson3, Scot Sternberg3, Gordon Schiff4,5, Russell Phillips3,5, Maria Rivera, DeeDee O’Brian, Meghan Dreilak
1
Bowdoin Street Health Center, Beth Israel Deaconess Medical Center, 2Healthcare Systems Engineering Institute, Northeastern University, 3Division of General Medicine, Beth Israel Deaconess Medical Center,
4
Center for Patient Safety, Brigham and Women’s Hospital, 5Center for Primary Care, Harvard Medical School
Motivation
Objective
• Diagnostic errors in primary care are costly and often are due to failures to follow
up (“close the loop”) on diagnostic tests, referrals, and symptoms
(1) Diagnostic tests and referrals often are not completed
(2) Tests and referral results often are not communicated to patients and PCPs
(3) PCPs frequently are not informed when symptoms evolve, altering diagnosis
• Methodical systems approach to closing loops on diagnostic processes will
measurably improve timely completion from approximately 70% to 90%
Aim to reduce diagnostic errors using systems engineering methods to 1) redesign diagnostic processes (diagnostic testing, specialist
referrals, and symptom monitoring) in primary care and 2) develop highly reliable and generalizable, “closed loop” systems
•
•
•
•
•
•
Conceptual Framework of Project
•
•
•
•
•
•
2021
Problem Understanding
2022
Solution Design & Testing
2024
2023
Solution Implementation
Impact Evaluation
Results
Methods
Problem Understanding
Data analysis of loop closure rates,
timeliness, and disparities
Statistical process control charts to
evaluate stability of process performance
Process mapping using Lean, human
factors, and reliability concepts
Failure Modes Effect Analysis (FMEA) and
Fault Tree Analysis (FTA)
Chart reviews and patient interviews
Simulation modeling of “loop of loops”
2020
Solution Design & Testing
Structural Analysis Design Technique for
design and ideation
Participatory patient-centered design
Quality improvement and health services
research approaches
Process improvement and redesign
Pilot testing and prototyping using
reliability design science concepts
Simulation modeling to evaluate
interventions and impact
•
•
•
•
Loop closure rates and timeliness of loop closure varies significantly based on the department and test site
Process maps highlighted areas most susceptible to failures and in most need of intervention and extra support
Failure analyses emphasized the severity and frequency of the failures identified in the process mapping stage
Structural analysis design technique diagrams and reliability design science concepts helped facilitate process redesign brainstorming
and new thinking which resulted informed potential solutions and pilot tests
SPC Charts
Process map
Rapid cycle pilot testing
Reliability Science Design Pyramid
High reliability
Low reliability
SADT Diagram
For more information, contact:
�CLOSED: Closing Loops by Operationalizing Systems Engineering and Design
Talya Salant1, James Benneyan2, Nicole Nehls2, Mark Aronson3, Scot Sternberg3, Gordon Schiff4,5, Russell Phillips3,5, Maria Rivera, DeeDee O’Brien, Meghan Dreilak
1
Bowdoin Street Health Center, Beth Israel Deaconess Medical Center, 2Healthcare Systems Engineering Institute, Northeastern University, 3Division of General Medicine, Beth Israel Deaconess Medical Center,
4
Center for Patient Safety, Brigham and Women’s Hospital, 5Center for Primary Care, Harvard Medical School
Lessons Learned
•
•
•
•
•
General
Systems engineering approaches have proven to be useful to study complex problems in
healthcare and improve and redesign care processes and outcomes
Improvement of loop closure rates in clinical domains that were heavily impacted by COVID will
have direct clinical and cost benefits
Incorporated equity as a key dimension of quality within our systems engineering will optimize
the generalizability and universality of our proposed systems redesign
Our model of collaboration, which integrates the perspectives of patient advisors, staff, and
experts from disciplinary fields both within and outside clinical care prompts us to be more
innovative and pragmatic
Our multidisciplinary approach to patient safety and quality may serve as a model for future
work in systems redesign
•
•
•
•
•
•
•
•
Solution Design & Testing
Need to consider patient diagnostic and care journey through the loop of loops
Need to find right balance of effort vs reward: Is the juice worth the squeeze?
Higher reward with focusing efforts on upstream processes (efficient, timely scheduling and patient
education) rather than further downstream (rescheduling after DNKAs)
Important to have primary processes that prevent failures for majority (~80%) of patients and
secondary processes to detect failures
Need reliable mechanisms and processes to detect and mitigate for patients with loops not closed
Processes and solutions should put emphasis on patients that providers are actually concerned about
(to reduce staff burden and information overload)
Need to generate more “out of the box” ideas that are still practical given constraints and priorities of
system
Need to operationalize and align sense of urgency between providers and patients
Publications
Benneyan J, White T, Nehls N, Yap T, Aronson M, Sternberg S, Anderson T, Goyal K,
Lindenberg K, Kim H, Cohen M, Phillips R, Schiff G (2020). Systems analysis of a dedicated
ambulatory respiratory unit for seeing and ensuring follow-up of patients with COVID-19
symptoms, Journal of Ambulatory Care Management, in publication. ID: NIHMS1714749
Nehls N, Yap T, Salant T, Aronson M, Schiff G, Olbricht S, Reddy S, Sternberg S, Anderson T,
Phillips R, Benneyan J (2021), Systems Engineering Analysis of Diagnostic Referral Closed
Loop Processes, under review
•Radiology paper under review
What is Systems Engineering?
•
Systems engineering is a structured approach and set of methods to methodically analyze,
design, and optimize effective processes that perform robustly and with high reliability
•
Different and complementary to traditional quality improvement and strongly advocated by the
Institute of Medicine, NIH, and others.
Includes human factors, process and failure analysis, design concept generation, rapid
prototyping, process design, reliability engineering, computer modeling, and systems
integration methods.
AHRQ’s Patient Safety Learning Labs grants are funded to integrate systems engineering in
patient safety initiatives.
For more information or assistance with systems engineering: www.hsye.org
•
•
•
For more information, contact:
Talya Salant, MD, Medical Director Bowdoin Street Health Center, tsalant@bidmc.harvard.edu
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tayla Salant (<a href="mailto:tsalant@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">tsalant@bidmc.harvard.edu</a>)
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Community Health Center
Project Team
Talya Salant
James Benneyan
Nicole Nehls
Mark Aronson
Scot Sternberg
Gordon Schiff
Russell Phillips
Maria Rivera
DeeDee O’Brian
Meghan Dreilak
Department
Any departments listed on the poster or identified in the spreadsheet.
<p>Bowdoin Street Health Center, Beth Israel Deaconess Medical Center</p>
<p>Healthcare Systems Engineering Institute, Northeastern University</p>
<p>Division of General Medicine, Beth Israel Deaconess Medical Center</p>
<p>Center for Patient Safety, Brigham and Women’s Hospital</p>
<p>Center for Primary Care, Harvard Medical School</p>
Dublin Core
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Title
A name given to the resource
CLOSED: Closing Loops by Operationalizing Systems Engineering and Design
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
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Effectiveness
Efficiency
Safety
Timeliness
-
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75752262bdb033bcbea59d0776080417
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Text
Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Pre-Intervention Survey
Effective Use of Time (Offgoing)
Post-Intervention Survey
Effective Use of Time (Offgoing)
Strongly disagree
(11%)
Disagree (49%)
Strongly disagree
(8%)
Disagree (15%)
Neither agree nor
disagree (4%)
Agree (32%)
Neither agree nor
disagree (0%)
Agree (39%)
Strongly agree (4%)
Strongly agree (39%)
Effective Use of Time (Oncoming)
Strongly disagree
(0%)
Disagree (10%)
Neither agree nor
disagree (17%)
Agree (62%)
Neither agree nor
disagree (0%)
Agree (50%)
Strongly agree (8%)
Strongly agree (40%)
A lot less (23%)
Neither agree nor
disagree (11%)
Agree (43%)
About the same
(8%)
More (15%)
Figures 1-3. Survey responses regarding preexisting signout process. N=47.
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
Opportunities
Likely to Contribute ___ to Burnout
Strongly disagree
(2%)
Disagree (9%)
Strongly agree
(36%)
•
Effective Use of Time (Oncoming)
Strongly disagree
(2%)
Disagree (11%)
Contributes to Personal Burnout
Key Results
Less (54%)
A lot more (0%)
Figures 4-6. Survey responses regarding
piloted signout process. N=10-13.
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
Next Steps
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Pre-Intervention Survey
Post-Intervention Survey
Average 37 Minutes per Patient
Average 25 Minutes per Patient
>60 (20%)
>60 (15%)
50-60 (7%)
50-60 (0%)
40-50 (4%)
40-50 (8%)
30-40 (26%)
30-40 (15%)
20-30 (30%)
20-30 (31%)
10-20 (13%)
10-20 (23%)
0-10 (0%)
0-10 (8%)
0
5
10
Key Results
15
0
1
2
3
4
5
Figure 7. Estimated time per patient completing entire
signout process. N=47. Typical census of 8 patients = 5
hours.
Figure 8. Estimated time per patient completing entire
signout process. N=13. Typical census of 8 patients = 3.5
hours.
Things Fall Between the Cracks
Important Missed Information
FREQUENTLY (9%)
•
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
NO (50%)
Opportunities
SOMETIMES (47%)
NOT SURE (30%)
INFREQUENTLY (45%)
YES (20%)
0
5
10
15
20
Figure 9. Estimated frequency of missed
information with pre-existing signout process.
N=47.
25
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
Next Steps
0
2
4
Figure 10. Oncoming providers’ report of later
discovered important information not covered
with modified signout. N=10.
6
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Handoff Redesign to Reconnect and Reduce Burnout
Mitchell Ross MD, Susan McGirr MD, Justine Blum MD, Rachel Hensel MD, Alicia Clark MD
Division of General Medicine, Section of Hospital Medicine
Introduction
Handoffs between Hospitalists going off
and coming onto service are frequent.
Our prior process involved extensive
written communication through multiple
overlapping documents but did not
require any verbal exchange. Burnout
from a cumbersome written process was
exacerbated by COVID-19, which also
made it more difficult for colleagues to
converse. By modifying the service
signout process, we aimed to improve
efficiency and reduce burnout
without sacrificing Hospitalist
preparedness to assume patient care.
Methods
First, Hospitalists were openly invited to
discuss the current signout process,
identify major problems, and offer
possible solutions. All Hospitalists were
sent baseline surveys, to which 47
responded. Based on the themes
generated, we proposed a modified
process abbreviating much of the
written communication and adding a
30-60 minute verbal handoff. This
modified process was then piloted over a
four-week period among all Hospitalists
providing direct patient care on the 12
Reisman medical unit. Participating
providers were surveyed after both giving
and receiving handoffs. 10-13 responses
were generated per question.
Provider Preparedness and Preferences
Key Results
Felt Prepared to Start on Service
Strongly disagree
(0%)
Disagree (10%)
Neither agree nor
disagree (0%)
Agree (40%)
•
More providers (77% vs. 36%) felt
the piloted signout process was an
effective use of time.
•
Reduced estimated time by 12
minutes per patient.
•
90% of oncoming providers felt
prepared to start after receiving a
verbal handoff with an abbreviated
written signout.
•
The majority of providers (6970%) preferred the modified
signout process.
•
77% of providers going off service
indicated the piloted process was
“less” or “a lot less” likely to
contribute to burnout.
Prefer Verbal Signout (Offgoing)
Strongly agree (50%)
Figure 11. Oncoming providers’ perceived
preparedness after receiving modified signout. N=10.
Yes (69%)
Not Sure (8%)
Prefer Verbal Signout
(Oncoming)
Yes (70%)
Not Sure (20%)
No (23%)
Figure 13. Offgoing providers’ preferences for or
against modified signout. N=13.
Opportunities
•
Improved human connection
•
Collaborative learning
•
Peer to peer feedback
No (10%)
Figure 12. Oncoming providers’ preferences for or
against modified signout. N=10.
Next Steps
•
Implementation on all direct care
(Attending only) services.
•
Incorporate verbal handoff into
teaching service signout.
�Warm Handoff Guidelines
SHOULD
SHOULD NOT
Focus on the most complex patients
Simply repeat information already written
Express uncertainty: what’s unknown
and/or undifferentiated
Explain deviation from standard of care
Read directly from abbreviated written
signout without adding context
Require the receiver to take notes
Include questions and clarifications
Be a one-way or lopsided conversation
Mention nuanced social issues
Be rushed or inconveniently timed
Ideally occur with medical record in view
Last more than an hour in most cases
Identify follow up communication needed
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Handoff Redesign to Reconnect and Reduce Burnout
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
PDF
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Mitchell Ross (<a href="mailto:mwross@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">mwross@bidmc.harvard.edu</a>)
Project Team
Mitchell Ross
Susan McGirr
Justine Blum
Rachel Hensel
Alicia Clark
Department
Any departments listed on the poster or identified in the spreadsheet.
Medicine
Hospital Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Handoff Redesign to Reconnect and Reduce Burnout
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/3bc8747e8f1f74802138a0f1d0095d26.pdf?Expires=1712793600&Signature=XQ0YfZSU6SHMOH5m7xDwvwK1v01Ck-zkWpR9F6IDXR9-TmM8B8-0-Hod3wJ9RgHcnmCBtjCpe8SXBQKcpJtyvx78eoceTU1MCGCEPwH1m-NMqYWO-LMpS-51MfQRUxNfE%7ECMwGvuOlKLhSY2lnSP2qjFdacLIoYGjmUjBQD2ZmA2XuYkNyaxxj%7EE9Rg0iMBvyU0a8GXlzBrtxXCSSilF31xpNcX2vX7dFZ2kpGIS0ZmAOlCRqc2kBfQ7hCXgk14iuHANVn%7EduZttLgvGVoJQ40cvAed4WUAtfrxxRrq-18tdINYEgNUJQscmBfPkfBrmnXnZN9ZKJsc48fp3UPdeFA__&Key-Pair-Id=K6UGZS9ZTDSZM
7b4e46f599997aab95ba2cd140ac7392
PDF Text
Text
Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube
Placement Improves the Confidence of Decision-Making
Liubauskas R. MD, Litmanovich D.E. MD, Chakrala N.L. MBBS, Oren-Grinberg A. MD, Eisenberg R.E. MD
INTRODUCTION
•
•
•
•
Following intubation, a frontal chest
radiograph (CXR) is obtained to
assess endotracheal tube (ETT)
position by measuring the ETT tip to
carina distance1
ETT tip location changes with neck
position, but it can be determined by
assessing the position of the mandible2
Since the mandible usually cannot be
visualized on standard CXR, we
developed a new protocol where the
mandible is seen in the CXR
We compared the confidence of
decision-making using new and
standard protocols for post-intubation
CXR to assess ETT position
WHY CARE?
•
•
An excessively distal ETT position
could lead to endobronchial intubation,
which may result in serious
complications such as3,4:
• Atelectasis of the
non-ventilated lung
• Hypoxemia, hyperinflation,
and barotrauma of the
ventilated lung with possible
development of pneumothorax
A too proximal ETT position may lead
to its displacement – caudal migration
and even self-extubation5, the
development of vocal cord injury,
resulting in permanent hoarseness and
significant airway obstruction3 and
ETT-related tracheal rupture resulting
from an overinflated ETT cuff
METHODOLOGY
Retrospective and prospective, single-center, IRBapproved study, which consisted of patients
undergoing CXR following intubation to assess the
position of the ETT-tip relative to the carina.
Two parts of the study:
• Part I- retrospectively assessed images obtained
with the standard protocol. Patients underwent a
routine supine AP post-intubation CXR for the
assessment of ETT position, in which the upper
margin of the image typically was in the lower neck
• Part II– prospectively included all consecutive CXRs
acquired using the new post-intubation protocol.
The radiology technologists palpated the mandible
to ensure that 1-2 cm of this bone would be
included within the upper margin of the image
What the heck is with the neck?
The position of the ETT depends on the
position of the neck2:
• If the neck is extended, the ETT ascends
• If the neck is flexed, the ETT descends
• Potential movement of the ETT tip can be up to
3.8 cm in cases where neck position changes
from flexed to extended or vice versa
• If the neck changes position between flexed
and neutral, or between neutral-extended, the
potential movement of the ETT tip is ~1.9 cm
In the study2,6:
• The neck is considered extended if the
mandible projects over C4 or higher
• The neck is considered neutral if the mandible
projects over C5 or C6
• The neck is considered flexed if the mandible
projects over C7 or lower
Where do we want the ETT to be?
The desired position of the ETT depending on the neck position6 (Figure 1; A, B, C):
• With the neck flexed – the ideal position of the ETT tip is 3 ± 2 cm above the carina
• With the neck neutral – the ideal position of the ETT tip is 5 ± 2 cm above the carina
• With the neck extended – the ideal position of the ETT tip is 7 ± 2 cm above the carina
We can be uncertain sometimes
We established “gray-zone” values (Figure 1) at which the
CXR are difficult to assess whether the ETT is in a satisfactory
position if the mandible is not visible:
• If the ETT tip-carina distance is >9 cm, then the ETT is too
high, regardless of the neck position
• If the ETT tip-carina distance is <1 cm, then the ETT is too
low, regardless of neck position
• If the ETT tip-carina distance is 6.0–9.0 cm, then the ETT is in
a high gray-zone position
• Rationale: if the neck is extended at the time the CXR was
obtained, the ETT is positioned appropriately. If the neck is
flexed, the ETT may move upwards with the neck in a neutral
or extended position, resulting in a too high ETT position
• If the ETT tip-carina distance is 1.0-4.0 cm - the ETT is in a
low gray-zone value
• Rationale: if the neck is flexed at the time the CXR was
obtained, the ETT would be positioned appropriately. If the
neck is extended or neutral, the ETT may potentially move
Fig. 2 – Algorithm to assess the ETT position downward, resulting in a too low position of the ETT
Making a confident decision
Algorithm for assessing the ETT position (Fig. 2):
Step 1 – is the mandible is visible on the CXR?
• If so, the position of the neck, and therefore
the ETT position, can be confidently
assessed. No additional steps
• If the mandible is not visible, go to step 2
Step 2 – is the tip of the ETT is in one of the
clear-zones?
• If so, the ETT position can be confidently
assessed regardless of the neck position
• If not, the ETT position cannot be
confidently assessed
Other times we’re sure
• Based on the “gray zones” - only when the
ETT tip-carina distance is 4.0-6.0 cm, can the
reader be confident that the ETT position is
satisfactory regardless of the neck position
• When the ETT tip-carina distance is either
>9.0 cm or <1.0 cm, the reader can be
confident that the ETT position is
unsatisfactory regardless of neck
• We established these ranges (<1.0, 4.0-6.0,
>9.0 cm) as “clear-zone” values, because
the reader can confidently recommend
moving or leaving the ETT in the current
position
Fig. 1 – Summary of different ranges of the ETT tip – carina
A – appropriate range of ETT tip when neck extended (5-9 cm)
B – appropriate range of ETT tip when neck flexed (1-5 cm)
C – appropriate range of ETT tip when neck neutral (3-7 cm)
X – Gray zone of the ETT being potentially too high (6-9 cm)
Y – Gray zone of the ETT being potentially too low (1-4 cm)
Z – Clear zone regardless of the neck position (4-6 cm)
Which zone is what now?
“GRAY ZONE” – ETT tip–carina distance, at which
it is difficult to assess whether the ETT is in a
satisfactory position if the mandible is not visible
“CLEAR ZONE” - ETT tip–carina distance, at which
the reader can confidently recommend retracting,
advancing or leaving the ETT in the current position
NB! - clear zone does not mean that the ETT position is
satisfactory, but that the reader can distinctly determine
whether the position is satisfactory or requires adjustment.
�Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube
Placement Improves the Confidence of Decision-Making
Liubauskas R. MD, Litmanovich D.E. MD, Chakrala N.L. MBBS, Oren-Grinberg A. MD, Eisenberg R.E. MD
RESULTS
•
•
•
•
There were 308 patients in the study with post-intubation CXR –
155 using the standard technique and 153 using the new protocol
Based on the mandible position, the neck was in neutral (45%;
78/173), extended (45%; 77/173) or flexed (10%;18/173) positions
There was a significant increase (p<0.001) in visualization of the
mandible on post-intubation CXR obtained with the new protocol
(92%; 141/153) compared to those with the standard technique
(21%; 32/155).
The distribution of mandible visibility and zones is summarized in
table 1 and figure 3.
ETT*
position
Certain
Standard
Protocol
32 (21%)
New
Protocol
141 (92%)
Mandible
Visible
Mandible
Clear zone 48 (31%)
7 (5%)
Not Visible Gray zone 75 (48%)
5 (3%)
Total
155 (100%) 153 (100%)
EXAMPLES FROM YOUR PRACTICE TODAY!
RESULTS
•
There were two acceptable ways to determine whether
the ETT was is in the appropriate position: by visualizing
the mandible, or by observing the ETT in the clear zone.
Combining both
measures, we
have estimated
that a confident
decision can be
made in 96.7% of
cases using the
new protocol,
compared to
51.6% of cases
using the standard
protocol (p<.001)
(Figure 4).
Table 1 Overview of
the study
results
Fig. 4 - Decision confidence rate when assessing
ETT position (new vs standard protocol)
CONCLUSION
Figure 3 - Using the standard protocol, there was an unconfident
decision rate of 48%, compared with only 3% using the new protocol.
•
When the mandible was visualized, it most commonly projected
over the C5 (32%; 56/173) or C4 (25%; 44/173) vertebral body,
with a range of C1-T2, suggesting that the neck is usually in a
neutral or slightly extended position (Figures 5 and 6).
Figure. 5 – Inaccurate interpretation of the ETT
position based on shape and angle of the
mandible. 55-year-old woman following
intubation with ETT tip 2.1 cm above the carina.
Recommendation to retract the ETT was not
made. Based solely on the shape of the
mandible, the neck may appear flexed.
Assessing by the relationship of the vertebral
body to the mandible, neck may be extended
(mandible projects over C4), introducing the risk
of ETT descending by approximately 2-4 cm
depending on neck movements, and possibly
intubating the right bronchus.
Fig. 6 – Inaccurate interpretation due to failure to
assess the relationship of the mandible to the
vertebral bodies. In this 66-year-old man following
intubation with ETT* tip 7.0 cm above the carina, it
was recommended to advance the ETT. However, in
assessing the relationship of the mandible to the
vertebral bodies, the neck appears to be in an
extended position (mandible projects over C3-C4),
making the position of the ETT appropriate, as it may
descend 2-4 cm depending on neck movements
To our knowledge, this study is the first study to
demonstrate that mandible inclusion on post-intubation
CXR is a simple and cost-effective method to ensure
proper assessment of the ETT position, sparing the
patients from unnecessary additional imaging and
almost doubling the level of certainty of the decisions
made by the radiologist.
REFERENCES
1.
2.
3.
4.
5.
6.
Godoy MC, Leitman BS, de Groot PM, Vlahos I, Naidich DP. Chest radiography in the ICU: Part 1, Evaluation of
airway, enteric, and pleural tubes. AJR Am J Roentgenol. 2012;198(3):563-71.
Conrardy P, Goodman L, Lainge F, Singer M. Alteration of endotracheal tube position. Flexion and extension of
the neck. Crit Care Med. 1976;4(1):8-12.
Mathew R, Alexander T, Patel V, Low G. Chest radiographs of cardiac devices (Part 1): Lines, tubes, non-cardiac
medical devices and materials. SA J Radiol. 2019;23(1):1729.
Owen RL, Cheney FW. Endobronchial intubation: a preventable complication. Anesthesiology. 1987;67(2):225-7.
Kearl RA, Hooper RG. Massive airway leaks: an analysis of the role of endotracheal tubes. Crit Care Med.
1993;21(4):518-21.
6. Goodman L, Conrardy P, Laing F, Singer M. Radiographic evaluation of endotracheal tube position. AJR Am J
Roentgenol. 1976;127(3):433-4.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Rokas Liubauskas (<a href="mailto:rliubaus@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">rliubaus@bidmc.harvard.edu</a>)
Project Team
Rokas Liubauskas
Diana Litmanovich
Nahara Chakrala
Achikam Oren-Grinberg
Ronald Eisenberg
Department
Any departments listed on the poster or identified in the spreadsheet.
Radiology
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Alternate Protocol for Frontal Radiographs to Assess Endotracheal Tube Placement Improves the Confidence of Decision-Making
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/bb47978d029e8ce272c5839b360ec759.pdf?Expires=1712793600&Signature=aUem1dQwzuTkgp3bS7eZPfdFrB82WemY2bn8DYJ0JDTmrNwD4BeiQQ%7Eh8ddl2z%7EiXJKCYP5xBXRKs%7E6rF7FABV8PtfiSJ1G0S0Qw2g%7E7eg%7ExA49RPBcMbAi3F8mGc-Wirl1BYN-pwoBKwmj6IUX-AvOaaoqDznMAr5xioSA-UBR1z4opBSCVSM7jkYglddjshUeCYO0cG%7E9CnP0dIVBsbigXi3uXVUUsA59FmCx2T8RtnjtEagwMDfs0a5dKNqq0KwmyeCcF%7EO2RN1wf1nvcsoroYjFo7orV2IyRQfiZEtVA922Pw0xbXTUhTH3l6sdcZ5SjC27U27oiKMwPt6jQbA__&Key-Pair-Id=K6UGZS9ZTDSZM
ed73b3c2a0bd82c41897ed01744307e5
PDF Text
Text
The Implementation of the Graduate Nurse Role to Support Nursing Staff during the COVID-19 Pandemic
Cassandra Plamondon, MSN, RN., Kym Peterson, MSN, RN, CNL., Kathy M. Baker, MSN, RN., Jenny Barsamian, DNP, RN., Ann Marie Grillo
Darcy, MSN, RN, ACNS-BC., Lynn Mackinson, MS, RN, ACNS-BS., Andrea Milano, MSN, RN, CCRN, CMC., & Lauren B. Mills, BSN, RN
Introduction/Problem
• Recognized critical staffing needs during the COVID-19 pandemic
• Governor Baker passed an executive order authorizing nursing graduates and senior nursing students
to practice with a limited capacity
• Current process did not support the role of the graduate nurse (GN) practicing in the clinical setting
Aim/Goal
• Increase the nursing workforce by implementing the GN role
• Swiftly create an orientation program that supported the GN amid the COVID-19 pandemic
The Team
Unit-Based Educators, Nurse Specialists, and Nursing Directors from inpatient medical-surgical and
specialty care units
The Interventions
Three phased approach tailored to the individual GN:
Phase 1
Phase 2
Phase 3
• Safety, basic assessments, documentation, prevention of harm, and use of basic equipment
• Advanced assessment skills, medication administration, emergency care, telemetry, and ECG monitoring
• Occurred once GN passed the NCLEX-RN exam and transitioned to the entry-level clinical nurse role
• Continued focus on medication safety, in addition to prioritization of care and evaluation of critical thinking
GNs were surveyed upon completion of orientation and their transition to the entry-level RN role to
assess comfort levels with various professional nursing roles and to identify knowledge gaps and areas
for improvement
The Outcomes
Fifteen of the 16 GNs successfully passed the NCLEX-RN and transitioned to an entry-level RN position with
12 responding to the survey. Six categories for discussion emerged:
Work experience
Communication and
feedback
Support
Clinical confidence
Workload
Transition challenges
• Ten had previous experience as a PCT, eight transitioned to a GN on the unit previously employed as a PCT
• GNs felt comfortable communicating with coworkers, physicians, and patients and their families
• Some reported a lack of communication regarding roles and responsibilities of the GN to other staff
• GNs reported seeking feedback for their performance
• Most felt supported on their units and felt the orientation process was well communicated with them
• Some stated that having several preceptors impacted the progression of their orientation
• Several GNs expressed lack of confidence in performing end of life care
• All felt they had adequate knowledge and experience to perform their job responsibilities
• Most felt comfortable with new situations and procedures
• Most GNs felt the workload was reasonable, feeling they could prioritize and organize patient care in a
timely manner and felt comfortable delegating tasks when necessary
• A lack of confidence and fear were challenges GNs identified during their transition to practice, followed by
perceived workload, role expectations, and how to use available resources
• GNs desired more experience with medication administration, eMAR, medical equipment, emergency
situations, and how to communicate efficiently with physicians
Implications for Future
• Improve communication with nursing staff to
increase the understanding of the roles,
responsibilities, and limitations of those in the
GN role
• Limit number of preceptors orienting a GN to
one or two key preceptors and ensure
communication occurs amongst those sharing
this role
For more information, contact:
Cassandra Plamondon, MSN, RN – cplamond@bidmc.harvard.edu
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Cassandra Plamondon (<a href="mailto:cplamond@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">cplamond@bidmc.harvard.edu</a>)
Project Team
Cassandra Plamondon
Kym Peterson
Kathy M. Baker
Jenny Barsamian
Ann Marie Grillo Darcy
Lynn Mackinson
Andrea Milano
Lauren B. Mills
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Nursing
Dublin Core
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Title
A name given to the resource
The Implementation of the Graduate Nurse Role to Support Nursing Staff During the COVID-19 Pandemic
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/055f07d74179b83ef0282d00dad2ad2f.pdf?Expires=1712793600&Signature=e-bWGwcI-RazVxL0s1RWVrPt2DMEy9OZajf9mEhso3y9T3r0P1I2Kov0yNCHbSnSXjZJS2E6BS3HwbM78RGVcSoZab%7EMuilG5R5zXt5HXgnk4baaeoX6izM-dPBWR1rtvDCC25o26pgPf9-8UnkoYu2bA2UimvugSKXmL9y8TfYbnB1jEGZMbgqFKNeb33SVvZIhsAj%7EcU-p9Y7bygyluE2tmj9nMIoTQk5UUzTzc2Zx0Es0ZPQ1PTix5rnwFEjIFgoDOY2sNQg4ep%7EIq5JZDFSi1b5lfObg7hbhdWm9vpHRiPUFOyiDnQ2pYxqdYnN8Ok6H-yUnxBCOsO0dXZiUrw__&Key-Pair-Id=K6UGZS9ZTDSZM
ee276e8f612864b4542a40aceed958bd
PDF Text
Text
JUST-IN-TIME IN-SITU SIMULATION REFRESHER TRAINING FOR THE PERIOPERATIVE CARE OF COVID-19 PATIENTS
SS Obeidat1, MJ Needham1, Jeffrey Keane1, Michael Chen1, L Zucco2, N Levy1, John Mitchell1, & SK Ramachandran1
1Beth Israel Deaconess Medical Center & 2Guy’s and St. Thomas’ NHS Foundation Trust
Introduction/Problem
Results
In-person
Virtual
Grand Total
Our just-in-time in-situ simulation training program, initially developed and implemented during the first
surge in March 2020, was reformatted in order to deliver refresher training to perioperative staff
members, from anesthesia, nursing and surgery staff members.
Anesthesia
199
73
272
In order to keep our practice of safe COVID-19 patients care in the perioperative setting and in
anticipation of the second surge of COVID-19, we provided in-situ training to “refresh” staff members on
the hospital updated specific workflow.
Surgery
12
4
16
Nursing
129
29
158
Grand Total
340
106
446
Feedback
Aim/Goal
The goal of the training was to assure staff readiness to safely provide care for COVID-19 patients,
minimize viral exposure and reduce the risk of transmission of COVID-19 to healthcare workers in the
perioperative setting.
Feedback reflected an appreciation for the brevity, the ability to complete training using the
preferred modality of the participant and the timeliness.
Feedback from staff members who were involved in the perioperative care of COVID-19 patients,
confirmed that appropriate protocols were followed in nearly 90% of all COVID-19 cases.
The Interventions
Refresher training was delivered over the course of 5 days in late November 2020, it was available to
each hospital site within the BI network. Attendance at each station/simulation scenario was tracked
using a QR code, which also contained a post-training question to assess knowledge of key concepts
within each station.
Given routine operating continued during the second wave, (staff members not readily available and
operating rooms would be occupied), we reformatted our COVID-19 training program to include
several modalities; online learning using a video recording, in-person training using drop-in stations
and didactic sessions through joint town hall meetings and grand round presentations.
Training Focused on donning & doffing of personal protective equipment (PPE), performing a COVID19 specific pre-operative huddle, and the use of appropriate infection control measures when
intubating or extubating.
For more information contact:
anesthesiaqsifellows@bidmc.Harvard.edu
For more information, contact:
�
Dublin Core
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Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
SS Obeidat <a href="mailto:%20">sobeidat@bidmc.harvard.edu</a>
Project Team
SS Obeidat
MJ Needham
Jeffrey Keane
Michael Chen
L Zucco
N Levy
John Mitchell
SK Ramachandran
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Anesthesia
Nursing
Surgery
Anesthesia
Nursing
Surgery
Dublin Core
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Title
A name given to the resource
Just-in-time In-Situ Simulation Refresher Training for the Perioperative Care of COVID-19 Patients
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Safety
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/01403eec0838fe9903bc585d2a4c7396.pdf?Expires=1712793600&Signature=LLSfmX4VPISy4PD7iZ7NNpiS8TR2BelMom3EVeUgNCWaQh-UHocOC9dAighq%7Ep7mS4iMp-hPJGEJG%7EIm3xKi1fgO5SgE%7EgZxfoM46Ya9O6XWNnAT3DBmIhoknYXFNE8ZQLxgzYtd6flGzQL%7EIPMYIMduzMnKi2z68m0a5m47U-Voc%7EudC7do1szDJaemWkpTjilALO8Tw78UqS61%7E0mLiFKWmWbG0ATpqLfj1XpOFy3bU1CDGHa0FZXugqgofyojamO3MFlM4qBLEzyGV3H1i7%7E0PPUxMgt1sGIa8Jo7TgiTfQKtNys4488B%7Efl5x7zeKhGwmo9PGQ3zE1zOkLO5hw__&Key-Pair-Id=K6UGZS9ZTDSZM
3162c576e41aefead167bc2f78bf9a19
PDF Text
Text
Hematology/Oncology Admissions
Tara Meekins RN and Tonia Valeri RN
Ambulatory Units: Shapiro 7, Gryzmish 7
Introduction
Our project is geared towards
Hematology/Oncology clinic
patients who have scheduled
clinic visits with same day
admission for chemotherapy. Our
clinic volume has increased with
higher levels of acuity as well as
the added burden of social
distancing during the Covid
pandemic which has made it
difficult to accommodate patients
waiting in clinic purely for an
available admission bed which
can take many hours. In order to
provide treatment for our
scheduled treatment patients
safely and without excessive
delay, we needed to alter our
planned admission process.
Method
The change of practice adopted is to schedule the patients
for planned chemotherapy admissions to clinic 24 hours
before their planned admission. The clinic visit entails a
pre-admission Covid swab, labs, any schedules test (i.e.
EKG/PFT/CXR) and physician exam that will authorize next
day admission. This also allows for high cost drugs (ie
Rituxan) to be administered on the day prior to admission.
t
Conclusion
Changing our planned admission
method to having our patients come to
clinic 24 hours in advance to their
planned admission (as opposed to
same day) has increased patient and
health care team satisfaction.
This has resulted in a quicker clinic
visit for the patient and allowed the
patient to wait in the comfort of their
home the next day to await for a
hospital bed for their planned in-patient
chemotherapy regimen.
This increases patient safety as it
allows time for a Covid swab to result
and helps support social distancing by
reducing crowding in the clinic.
This has also helped healthcare
team members, giving adequate time
to analyze lab results and organize
appropriate oncology intervention with
appropriate bed placement (ie shared
or private room).
�Hematology/Oncology Admissions
Tara Meekins RN and Tonia Valeri RN
Proposal for Planned
Admissions
1. Moving forward, all planned
admissions will have Clinic visit
(MD/NP appointment) with labs
and Covid swab done the day prior
to planned admission. Along with
labs and covid swab, the
practitioner will verify with 7F or
11R that the planned admission is
in the book and that the patient is
cleared to be called from home the
following day to come in when bed
is ready. MD will place and sign
future Chemotherapy order.
Day -1
2. Patients will be called at home by
the admitting floor the following day
when room is available to come
into the hospital for planned
admission.
Day 0
Ambulatory Units: Shapiro 7, Gryzmish 7
Advantages of next day Planned Admits
Increased patient satisfaction, allowing them to wait comfortably at home for
an available bed as opposed to in a busy clinic lobby for prolonged time.
This will also help increase safety, ensuring a covid swab is done with a
reliable result time for that covid swab before admission.
Next day admission allowed a quicker clinic visit which reduced waiting for a
bed in a crowded lobby.
Allows clinician to verify that patient is in the book for planned admission to
ensure a bed will be available the next day.
Limited bed holds for patients that may not be eligible for the planned admit
due to abnormal lab results. This results in better utilization of limited
in-patient beds.
Fiscally, this allows providers to charge for a clinic visit as it won’t be on
same day as admission.
This also allows us to charge for any RN intervention or treatments such as
administration of Rituxan as it is separate from admission day. We can’t
credit a charge on the same day as admission from the clinic.
Resource Nurse can now focus on supporting nursing care to the scheduled
patient treatments in the clinic and focus on unplanned admissions as
opposed to acting as a liaison to the same day admission process (checking
bed status and providing updates and then transportation for patient to get
to floor).
Advantages of next day
Planned Admits
This allows physicians time to fully
review lab results along with
patient evaluation to determine
safety of planned admission for
chemotherapy.
This also allows time to write the
chemotherapy regimen in advance
(Day -1), ensuring it is signed and
ready to be verified on admission
(Day 0).
This gives time for all the
healthcare team members to
prepare for the admission,
including nursing and pharmacy.
Ultimately this reduces delays,
increases safety and satisfaction
for the patient being admitted.
�Hematology/Oncology Admissions
Tara Meekins RN and Tonia Valeri RN
Ambulatory Units: Shapiro 7, Gryzmish 7
Nursing Professional
Governance
Allowing nurses the time to evaluate
practice and work environment to find
areas of improvement and
empowering them to help implement
changes to these areas help improve
patient satisfaction and outcomes
along with increased workplace
satisfaction.
Disadvantages of Same Day Admissions
● Patients voice frustration and dissatisfaction with the long wait time before
their bed is available for them. They voice feeling “forgotten about” when
they are left in an exam room or in a busy lobby.
● As the clinic volume has increased with higher levels of acuity, it is
becoming very difficult to accommodate patients waiting in clinic purely for
an available admission bed. We have limited spaces to provide scheduled
treatments and have increasingly had a waiting list for patients to come
back to treatment area due to no beds or chairs available. This results in a
very full lobby and delays in care.
● It becomes harder to provide safe environment with social distancing with
clinic volume increasing.
● It is and will continue to be important to have a covid swab result to
determine treatment and bed placement, there are times when same day
admissions have not had their covid swab done or resulted in time.
● There are instances when planned admissions were not communicated
correctly and the floor has no bed reserved, resulting in a scramble to find a
bed, sometimes after 6pm which delays onset of planned treatment to the
next day.
● Treatments or interventions done in clinic can not be billed if patient is
admitted on same day. Hospital does not get reimbursed for high cost drugs
like Rituxan administered in clinic if patient is admitted the same day.
Changing Disadvantages to
Advantages
Shapiro 7 - Gryzmish 7 - Feldberg 7
This change was initiated by the
nurses in the ambulatory setting to
help with our admission process.
Oncology is increasingly moving to
the outpatient setting which has
resulted in large clinic patient
volumes. This is a challenge to our
limited physical space and limited
time in the clinic day. The Covid
pandemic has added to this, having
to ensure proper patient symptom
screening and maintaining social
distancing.
Our planned admission process
was one area we focused on to help
reduce crowding in the clinic. We
worked in collaboration with the
physicians, admitting floors and
pharmacy to ensure the proposed
changes were safely implemented.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Tara Meekins (<a href="mailto:tmeekins@harvard.bidmc.edu" target="_blank" rel="noreferrer noopener">tmeekins@harvard.bidmc.edu</a>)
Project Team
Tara Meekins
Tonia Valeri
Brendan Sendrowski
Caroline Meijas
Sarah Marcinowicsz
Jo Underhill
Matthew Weinstock
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Hematology and Oncology
Ambulatory Units Shapiro 7
Ambulatory Units Gryzmish 7
Pharmacy
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hematology/Oncology Admissions
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Efficiency
Safety
Timeliness
-
https://d1y502jg6fpugt.cloudfront.net/13418/archive/files/be26ada387978e266df6fd27aa9f4f25.pdf?Expires=1712793600&Signature=e3aY7zI9-LWGsS7vvlDIw9kK5mG-JmyH-QRi1g%7EE3866nupOUThUCS5qq2PcTN36ZwgmAZVBqutKJe%7ELMDBWL3YmDNWwceWvysWKKWSYUfZoT7tL1nDTfUpUpUfpAbGYDWCYclYPKZdkYgjq1iLx3Qo6uyenrtsDqGTJ547pZuur0UNsu7YMCaqsjxNjmzKALY93I3GAinxhvdoOtfbvR6akcsLS8j5K1k5WwzpqeZ53wWt3V9YQZYnTI2iR3oP%7E6lrLeFgDfN8ovu2djp3T6ujihy50sJEvEb3JXec5Rw2OEOKw0HsduWC2J4mEu6rVSEr7mj%7EC51DCI6YRB4IUtQ__&Key-Pair-Id=K6UGZS9ZTDSZM
3c6f5f0f9aaef4f2c74ff5f8136acce3
PDF Text
Text
Rolling Out Remdesivir Under EUA
By Julius Yang, MD and Jaime Levash
Beth Israel Deaconess Medical Center
Introduction/Problem
Results/Progress to Date
May 1, 2020 the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for
the emergency use of remdesivir for the treatment of hospitalized patients with severe COVID-19. EUAs
are a relatively new pathway that the FDA can utilize when there is a declared health emergency. During
the health emergency, things were moving quickly.
Aim/Goal
The goal was to understand the EUA and roll out the medication across the medical center as quickly as
possible to help save patients’ lives.
May Adra, PharmD
Michael Cocchi, MD
Mary Ifeoma Eche, PharmD
David Feinbloom, MD
Kyle Franko
Howard Gold, MD
Margaret Hayes, MD
John Hrenko, RPh
Mary LaSaliva, MD
The Team
Jaime Levash
Christopher McCoy, PharmD
Ari Moskowitz, MD
Ameeka Pannu, MD
Todd Sarge, MD
Roger Shapiro, MD
Lauge Sokol-Hessner, MD
David Sontag
Conor Stack, MD
Margaret Stephan, RPh
Kathryn Stephenson, MD
Kim Sulmonte, DNP
Daniel Taupin, MD
Cheryle Totte, RN
Julius Yang, MD
The Interventions
Created three working groups:
– An Oversight Committee has met to oversee guideline implementation, monitor drug supply, ensure
effective communication with staff and patients, and ensure adherence to ethical, regulatory, and
patient-centered best practice.
– A small Interdisciplinary Advisory Workgroup was developed a consensus allocation prioritization
guideline based on available evidence and experience regarding treatment of COVID-19 with
remdesivir.
– A Clinical Review Team met daily to review patients potentially eligible for remdesivir EUA allocation
per BIDMC guideline, and authorize release from Pharmacy for individual patients.
83% of patients treated with Remdesivir were
discharged home or still in the hospital. Only
17% of patients who agreed to treatment
expired.
Lessons Learned
Create a multidisciplinary team.
Clear communication to providers explaining the steps to communicate with their patient, order the
medication, and documentation needed.
Administration of remdesivir earlier in illness is more beneficial then later in illness.
Next Steps
The 3 workgroups dismantled. Remdesivir was approved by the FDA in early October 2020 which means no
longer a need to complete additional tracking on the amount of medication dispensed, no formal reaction
tracking to the FDA, and no prioritization amongst patients since supply was abundant.
For more information, contact:
Jaime Levash, Senior Project Manager Health Care Quality
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Jaime Levash (j<a href="mailto:jlevash@bidmc.harvard.edu" target="_blank" rel="noreferrer noopener">levash@bidmc.harvard.edu</a>)
Project Team
May Adra
Michael Cocchi
Mary Ifeoma Eche
David Feinbloom
Kyle Franko
Howard Gold
Margaret Hayes
John Hrenko
Mary LaSaliva
Jaime Levash
Christopher McCoy
Ari Moskowitz
Ameeka Pannu
Todd Sarge
Roger Shapiro
Lauge Sokol-Hessner
David Sontag
Conor Stack
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Department
Any departments listed on the poster or identified in the spreadsheet.
Pharmacy
Marketing and Communications
Infectious Disease
Healthcare Quality and Patient Safety
Nursing
Emergency Medicine
Anesthesia
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Format
The file format, physical medium, or dimensions of the resource
pdf
Title
A name given to the resource
Rolling Out Remdesivir Under EUA
Effectiveness
Safety